Relapse is not rare or unusual, it is the norm, but it feels terrible. The text following is the whole content of the short book “Understanding and learning from relapse”. It looks at the reasons we fail to stop or limit our drinking when we want to, and it shows how to overcome the hurdles that caught us in the past and win through. You can read it here, or if you prefer you can download it as an eBook on this page.
The likelihood of an alcoholic managing to become alcohol-free at their first attempt is extremely small.
The data on alcoholics recovering in the community (i.e. without professional help) are rather unreliable, but less than 20% of patients who receive treatment for alcoholism (i.e. this does not count those recovering in the community) remain alcohol-free for an entire year. However, while the first year can be the hardest, the relapse rate does go down over time. For people sober for two years, 60% remain alcohol-free for the rest of their lives, and people who have been sober for five years are almost certain to stay sober.
Another statistic shows that of 1,000 people deciding to try and stop drinking only 50 will still be abstinent after 90 days and of these 50 only two or three will still be continuously sober after two years.
Yet, at complete odds with these depressing numbers is the fact that most alcoholics do recover. Three quarters of people diagnosed as alcoholic will at some stage recover. This seems to completely contradict the statistic that says only two or three of 1,000 people starting out will manage to achieve 2 years of continuous sobriety… but it is not. The key word in that statistic is “continuous”. It does not say that only two or three of the 1,000 will recover. What the statistic says is that 997 or 998 of that 1,000 will experience a relapse at some stage in their first two years.
The evidence is clear that virtually everyone trying to become alcohol-free will relapse, but as inevitable as it may be it is an utterly devastating experience. However, most people who experience relapse will then go on to become sober. The data shows that you are far more likely to achieve an alcohol-free life if you experience relapse along the way.
Of 1,000 people starting out to stop drinking, only two or three (that is 0.25%) will make two years without picking up a drink. Yet about 750 of those 1,000 recover; they relapse and then go on to become alcohol-free. But it does not take 4,000 attempts to do so. Relapse while trying to become sober is not only virtually inevitable, it increases your chances of succeeding the next time you try. It is a learning experience that can dramatically increase the likelihood that your next attempt will be successful. But relapse is also a soul destroying experience, and one to be endured as few times as possible.
This booklet is written to help you learn the most you can from the experience of relapse, and then to move on again. If you have just experienced relapse then you’ve been confronted by one of the many challenges we meet in becoming alcohol-free but failed to negotiate it successfully. This is entirely to be expected. When we first set out on this task we have no idea how difficult or how broad the challenges are, we only discover this as we progress. Falling at an obstacle we’ve never encountered before isn’t failure to complete the whole course; it is failure to pass a particular obstacle on the course the first time we meet it. But we don’t just get one attempt. The next time we attempt that obstacle we will do better.
Relapse is the experience we need in order to succeed in becoming alcohol-free.
If you’re reading this and have just relapsed then you don’t need to be told this. The experience of relapse is really awful.
Being back on “Day One” was utterly devastating. How come the great, capable, all-conquering me that could do almost anything I set myself to couldn’t do this one simple thing? What made it worse was that most people in the world could stop drinking for a week or so if they wanted to, but I couldn’t. It felt like I was a total failure; useless, worthless, weak… hopeless. I’d drunk again but that was not what was meant to happen. I was supposed to be stopped, but I drank again. I couldn’t explain what had happened properly because the problem hadn’t come to me in words, it had come as feelings, and on this occasion (again!) the feelings had overwhelmed reason. Relapse is a crushing and confusing experience. Stopping drinking is hard and I never understood quite how hard it was until I tried. It’s hard because sometimes the test can be ferocious, and sometimes it can be devious… my addiction kept finding new ways to challenge me. Until I realised just how hard it was, and how devious it could be, I didn’t bring enough to the attempt… that’s my experience. But relapse isn’t failure, it is education. It is an essential step on the path to recovery. It is only through successive failures that we finally learn how to overcome the addiction and then how to remain alcohol-free. Relapse is not the end of a recovery effort; rather it is another step along the road to recovery.
Relapse doesn’t put you back at the start
If, while I was still drinking, I ended up castaway on a deserted island for a year, then my count of sober days would be 365. If however I was rescued and brought home then I’d have got completely wasted at the very first opportunity. The 365 days without a drink was no indication whatsoever of whether or not I would drink again.
Stopping drinking for a period does not cure alcoholism. It stops it progressing further, but it does not cure it.
While I was still drinking I hadn’t fully grasped the severity of my condition, let alone begun to confront it. On that imaginary deserted island I’d clocked up 365 sober days, but my progress towards recovery was still zero… nil, zip, nothing. I hadn’t even begun to fix my problem… I didn’t even acknowledge that I had one. I had 365 days of continuous sobriety, but I wasn’t even in the starting blocks of recovery.
We often count days since we last drank as a measurement of success. But it’s important to recognise it for just what it is, or more importantly, what it is not. The number of sober days we have accumulated only means the number of consecutive days of abstinence. It is a measure of sobriety, not recovery.
Recovery is measured by our mental wellness, not the length of time since our last drink, and the two can be completely independent of each other. If we drink again then our length of continuous sobriety is lost… but our recovery isn’t.
Learning to be sober
Stopping drinking is difficult, and just like other difficult things it takes time to master. We become proficient at doing things with practice, and we advance the most on the back of mistakes; this is how we learn.
My first failures at stopping drinking were failures to limit the amount I drank. These were times when the intention was to “just have one”; but that’s never how it ended. If I started drinking then I always had more… there was no such thing as “one” drink. Following this there were attempts to stop for a short while, but these would collapse within a few days (or sometimes hours). When I finally started to recognise the severity of my condition then there were more serious attempts at stopping; all ending at a bottle.
All of these were relapses; occasions where my intention to not drink was not met. But each of these taught me something about how to succeed. Recovery is not a smooth linear process but a progression of learning steps that build on each other, and some of these learning steps are relapses of one sort or another.
Learning to be alcohol-free is very like learning to ride a bicycle. The first challenge is to manage staying upright while making forward progress. How many times did I fall before achieving that? But once I’d learned how to maintain balance and move in the direction I wanted to there were still many occasions when I fell… because the problem had changed. Yes, I knew how to keep my balance, but sometimes I grew over-confident, and sometimes something unforeseen would happen and I’d be down on the ground again. Stopping drinking is a learning challenge that is very much like this; it changes. When I first tried to curb my drinking the cravings, those wordless demands that I drink caught me time after time. Eventually I learned to confront and overcome the cravings and managed to string a few wobbly days together. Then I gathered speed and confidence and set off careering down the sober road, but that’s not where the learning story ends. Once I’d learned to balance on my bike the challenge became different. It no longer took all my concentration to stay upright; I’d mastered balance. The challenges now were overconfidence and the unexpected: I’d try to go too fast, or something unforeseen happened like suddenly hitting a slippery patch while I was cornering. These are precisely like the challenges I met when I’d chalked up a few sober days; I became over confident (“perhaps I’m cured”, “I can manage just one” etc.) or I failed to negotiate something that was sudden and unexpected. When I first got sober the challenge was relentless… a continuous and furious concentration, but once past that the challenges came “out of the blue” or were of my own making (e.g. putting or finding myself in vulnerable situations). We don’t just get one chance at learning to ride a bike. If we did, then nobody would ever succeed. When we fell it wasn’t because we chose to, it is because we lacked the expertise not to. We had to fall in order to learn and we learned by our mistakes. Stopping drinking requires similar learning. Relapse isn’t failure; it is the growth that allows us to succeed. But that isn’t how it feels at the time.
Relapse is a part of recovery
Relapse feels absolutely awful; it feels like complete and total failure. All we had to do was one simple thing, something that everyone else in the world seems to do quite easily… but somehow we couldn’t do it. It feels so bad you want the earth to open up and swallow you. The position seems more hopeless than ever. The earlier sense of impending doom and hopelessness is back in full force, deepened by the new evidence that for us it really is impossible to stop drinking. We feel utterly useless. Not only have we failed ourselves, we have failed everyone else too. We feel useless, worthless, helpless and hopeless. We are at our wits end and in total despair; it seems there is no escaping alcohol.
That is what it feels like, but this isn’t the truth of our position.
Relapse is a part of the process of recovery, not the end of it. We don’t have to go right back to the beginning and start the process all over again. When I fell off the bike I wasn’t put back at the start of learning how to ride, I was exactly as far advanced along that path as I was when I fell. Nothing was lost other that a bit of pride and skin. Everything that had been learned was still learned and because of this fall I would achieve more at my next attempt. Relapse while trying to stop drinking is precisely like this. Nothing is lost. We are not back at the start of recovery. We still know everything that we have learned thus far and we just learned something new. A relapse does not put us back at the beginning of our recovery. In fact, as long as we learn the lesson from the event, it advances us.
When we first set out to get sober the challenge is a continuous and daily struggle. There will be many stumbles in this period. But over time the power of those cravings diminishes and our days pass without having to constantly fight the demand to drink. This is just like learning to balance on a bicycle: once we have mastered it and practiced for a while it becomes automatic and we no longer need constant concentration to remain upright. As we close the doors to alcohol one-by-one our addiction searches for the ones that are still open. One of the great challenges we face in getting sober is that, just like learning to ride that bicycle, the problem changes.
If you have just relapsed then your addiction found a door was still open and you stepped through it. Learning to ride a bicycle requires practise, and that we learn to ride safely from the times that we fall. The same is true of recovery. We need to learn from our mistakes if we are to proceed without falling again.
Stopping drinking is hard and we don’t understand how hard it is until we begin. As we start out we are completely unaware of the full ferocity of cravings or all the ways that our minds will try to trick us into drinking again; we only discover these as we advance. Sometimes these will catch us out and we drink. But relapse isn’t failure, it is education. It is an essential step on the path to recovery. It is only through successive relapses that we finally learn how to break the addiction cycle, and from there we learn how to remain alcohol-free.
If you have just relapsed then you should remember that the problem hasn’t got worse because of it, it is exactly the same as it was. You are still an alcoholic. You still can’t limit or control your drinking, and continued drinking will drive you deeper into the downward spiral of despair.
It has to stop. You have to stop drinking if your life is going to improve. The problem is unchanged. What has changed though is your ability to overcome it.
If we only got one attempt at learning to ride a bicycle then nobody in the world would be able to do it… yet millions can. Similarly, nobody ever said you only get one chance at getting sober; you don’t! You get as many as it takes.
Nobody, absolutely nobody is able to completely stop drinking at the first attempt; it is always preceded by relapse in one form or another; failure to limit the amount we drink, failure to not drink on an occasion, or failure to drink for a period of time. We don’t need to have some rare super-power to stop drinking. What we need is to learn from our mistakes, and the persistence to try again.
Using relapse to strengthen your effort
You are not back at the beginning again if you have relapsed. The good days while you stopped drinking are still good days, and the bad days when you did drink were important lessons. Both the good days and the bad days are experiences to draw strength from.
The good days show you that not only can you do this, but that it is worthwhile. In those good days you didn’t wake up feeling wretched. You didn’t come to wondering what you’d done the night before or who you’d said what to. You didn’t wake feeling wracked with the guilt and shame of what you’d done. You didn’t fail to do important things because drinking got there first. You didn’t make things worse for yourself. Life was better on those days than it was while you were drinking.
The bad days hold the important lessons that must be learned. A door was still open to your alcoholism, and you walked through it. You need to identify that door, close it, keep it closed, and then move on, stronger and wiser for the experience.
Relapse comes in many forms. The first relapses we endured were failures to limit our drinking when we wanted to… e.g. “I’ll only have a couple”. It was when we realised that we couldn’t follow through on that commitment that the alarm bells first started ringing. Then there were the intentions to not drink at certain occasions or places, and again, the alarm was raised. In time we recognised that our drinking was out of control and we had to do something about it; something drastic, something unthinkable… we had to stop. This call to action was raised on the back of these earlier relapses; occasions when our intentions to abstain or limit the amount we drank were not achieved. We only realised that we must stop drinking based on our failures to limit and control it.
Recovery is built on the experience of relapse. It is these failures and near misses that allow us to progress into a life without alcohol; but only if we learn from them.
When we pick up a drink we do so to satisfy an automatically induced “wanting” or “longing” for alcohol. We experience this as a craving. It is the brain’s way of motivating us to do something that’s deemed to be beneficial in some way. But these cravings do not occur randomly, they are induced automatically when certain conditions are perceived. These conditions are known as triggers, and the simplest trigger for us is seeing alcohol close by; this automatically initiates a craving to drink. We alcoholics develop very many triggers that induce a craving to drink, and for those of us that drank heavily over a long period those cravings become enormously compelling.
Cravings to drink are not voluntary. We can’t turn them off because they are entirely automatic, and they are hard to ignore because they are instructions that work at an instinctive level… there is no conscious thought involved at all.
When we first try to limit our drinking we discover to our horror that we can’t. But as our decline into the depression of addiction deepens we realise that “can’t” isn’t a survivable option… we must! It is a fight between a seemingly immovable object and an irresistible force; on one hand we can’t stop drinking, yet on the other hand we have to. If we are to live worthwhile lives then we must somehow manage to stop drinking, and that means overcoming the huge cravings induced by our triggers. This is enormously difficult.
Every time we drink in response to a craving then the power of the trigger is increased. The brain recognises when a trigger successfully returns the desired result, and when this occurs the relative importance of that trigger is increased, and the importance of a trigger determines the power of the craving it will induce.
We have very many of these triggers, and we have satisfied them so many times that the cravings they induce are enormously powerful. These triggers end up being so powerful that they are more urgent than for example; returning to work on time, driving safely or even eating.
But in exactly the same way as a trigger is strengthened when it successfully delivers the desired object (alcohol in our case), it is reduced in importance when it does not yield the objective.
Every time we resist a craving, then the power of the next craving induced by that trigger is diminished. This is incredibly important and is worth repeating.
EVERY TIME WE RESIST A CRAVING, THEN THE POWER OF THE NEXT CRAVING INDUCED BY THAT TRIGGER IS DIMINISHED.
This is how we manage to stop drinking. We do not stop drinking because we get better at resisting cravings. We stop drinking because the cravings fall to an intensity that is no longer compelling. One day we look back and see that the constant cravings have disappeared.
By denying cravings, from many triggers, over an extended period, then our cravings for alcohol diminish to a level that can be easily managed. When we successively deny the cravings over an extended period then we end up yearning for a drink no more than, for example, a donut that we might see in a baker’s shop window.
At first the challenge is incredible as the cravings run nearly continuously and they are enormously powerful. But each craving resisted is progress, and in time they fade in intensity. Over time the most commonly fired triggers lose their power. However, the infrequently fired triggers still have their full force. This highlights the two periods in which we are most likely to relapse:
- In the early stages of sobriety while the call to drink is nearly continuous, and
- in the secondary stage of our sobriety when a big craving suddenly pops up seemingly from nowhere.
By far the most important thing about a relapse is what we learn from it… how to improve our performance for the next attempt. This is how we learn. This is how we grow. This is how we succeed. There is no point whatsoever in going straight back to trying to stay sober without learning from the experience of a relapse. If we do so then we are destined to fall at the same hurdles again and again. If we deny cravings then their power subsides. It is not our lot to endure the misery of fighting off enormous cravings for the rest of our lives. It seems like this in the beginning, but that enormous effort yields a huge return; one day the cravings stop! At some point in the future you will realise that you haven’t been challenged to drink or even thought about alcohol for a day or so. This is the reward we get from denying cravings. It is hard earned, but priceless beyond measure; we get our lives back. Fending off the cravings is enormously difficult but the very great news is that those cravings decline far faster than the years it took to build them up.
Relapse in the first days and weeks
When we first try to stop drinking then we meet the cravings at their most potent, and they are nearly continuous. We fall at this hurdle many times, principally because we don’t bring enough to the fight; we’ve never experienced the full power of cravings like this before so we’re unprepared for the severity of the challenge. We learn that this is a very stern test indeed, and that it takes all that we have (and more) to get past these first days of cravings.
At first the cravings come nearly non-stop. This is because the main triggers to drink are grouped around our daily routine; where we are, what we are doing and who we are with. Everything about our daily lives had become associated with drinking, and though we can change our routines to a certain extent, we can’t change all of them completely. When we first try to stop drinking we are confronted by a constant and visceral demand that we drink. The effort becomes enormously draining. The cravings are automatically triggered, powerful and incessant, and we have to fight them off with nothing but willpower. When we fall at this stage we have become too exhausted to fight back effectively, and we succumb.
The issue here is fatigue; we simply can’t sustain the effort. While we know without doubt at an intellectual level that we shouldn’t drink, that isn’t where the battle is fought. The compulsion to drink is experienced in feelings, not logical argument, and the only thing we have to combat those feelings with is willpower. But our willpower is finite. If we are routinely falling in these early stages then we need to look at what we can do to make the problem manageable. What can we do to reduce willpower fatigue? What can we do to lift and replenish or resolve? And what can we do to change the pace, and the ferocity of the cravings?
We have to combat cravings with willpower, and just as cravings are cyclical, so is resolve. When the craving is small but resolve is high then there’s no problem, but when it’s the other way around, when the craving is severe but resolve is low, then the likelihood of us giving in and drinking is very high. As well as the peaks and toughs of resolve there’s also fatigue. We need to do things that will lift our resolve and avoid the things that will diminish it.
Constantly fighting the demand to drink is tiring, and resolve can simply be worn down until there’s nothing left to fight with. But there are things we can do to boost and restore resolve.
Initially we are going to experience intense periods of feeling low because of the lowered ambient dopamine level in our brain. Not only do we feel miserable we feel desperately alone. This social deficit is caused by a lowered serotonin level. These are direct consequences of drinking heavily for an extended period and then stopping suddenly. It takes time for the brain to re-establish the correct dopamine and serotonin levels, and until it does we are going to experience feeling alone and depressed far more often than we feel uplifted. Despite struggling hard and making daily progress we are still going to feel miserable. This is inevitable; it is what must happen as our body and mind suddenly adjust to the absence of alcohol. It is a part of becoming well, and it is important to try and remember this when we are down. It is what should be happening. But while this is inevitable, it also saps our resolve, and we need to do everything we can to keep that high; it is our only defence against cravings. There are some things we can do that will fully top-up our resolve, and we need to engage in as many of these as we can and as often as we can.
If you have been seeing a counsellor then you’ll notice that you are always brighter afterwards. The same is the case for any regular alcohol self-help groups; 12-step or other meetings. We are helped enormously by talking to other people about getting free from alcohol and staying free. It confirms that we are ‘doing the right thing’ and that we are trying to achieve something important. It confirms that it is possible to become alcohol-free. It confirms it is worth the severe discomfort of becoming alcohol-free, and it keeps ‘front and centre’ the things we need to do to get there. It stands us back up when resolve is low.
If you are engaged in a therapeutic activity like this then keep going! Often we feel down and can’t be bothered to go, but that is the very time that we most need to. Spending time talking about recovery and talking to other alcoholics will always help when we are down, so don’t let opportunities to help yourself slip past because you don’t feel like it. Bully yourself into going if necessary; you won’t regret going afterwards. If you are offered the contact details of people to call when things get bad then take them. They are offered for a very good reason, and you’re likely to need that help sooner or later!
Exercise is perhaps a surprising thing to suggest for someone trying to stop drinking, but there are several clear reasons to engage in some regular activity. The first is a very simple thing about feeling good about ourselves. Our bodies have taken a battering from alcohol, and exercise makes us healthy. When we think we are doing something that’s good for us then we feel better about ourselves. If this exercise can also be social, then there is another benefit. Learning to socialise without alcohol is a major challenge in its own right, but in the context of willpower and cravings one of the biggest challenges is time spent alone. This is when we go into our own head-space, and it almost always has unwanted outcomes. Time spent in the company of others is time not spent alone. The last and simplest reason to take exercise is that it releases endorphin into the system.
Endorphin makes us feels good about ourselves and it is also a relaxant (i.e. it relieves stress), and as we struggle to stop drinking we need both of these. The exercise needs to be enough to get your heart pumping fast for at least 20 minutes, but the nature of the activity doesn’t matter at all. The endorphins this releases will give you a boost for up to 12 hours.
Things that damage resolve
Hungry, Angry, Lonely, Tired: HALT. It’s an acronym often used to warn people in recovery of things that are going to make them more vulnerable to picking up a drink.
“Angry” gives us an opportunity to retaliate, and that retaliation will be to storm off and get drunk. It is a hard one to defend against at a time when we are irritable and very low on tolerance. The best thing is that we know that this is a major risk for us; our brain is in great turmoil so we are almost certain to get angry at some stage. As we struggle through withdrawal and the weeks that follow we suffer extreme mood swings. This is completely normal and to be expected but it also means that we will over-react to things that people say and do. When this happens we need to somehow find ourselves time and space to calm down, but in this time we are extremely vulnerable. If this happens DO NOT RUSH INTO THE NEAREST BAR OR LIQUOR OUTLET. Do anything at all, but give yourself time. Walk, drive, or run in the opposite direction if you can, but give yourself time to recover. Drinking will not improve what has just happened, it will make it worse. You need to buy yourself some time for this truth to come through.
“Hungry” should be an easy one to remedy, but it is not necessarily so. A normal symptom of withdrawal is loss of appetite. This means that we will get run down and lack energy, and sugar is the fast remedy for this. We are likely to want to snack on sweet things, so keep some available. It takes time to re-establish a regular eating pattern, so a supply of tasty snacks and treats are a good idea until your normal appetite returns. If you put on a few pounds then so be it; that can be attended to later. Right now the most pressing thing is to not drink.
“Tired” is going to happen; it’s inevitable. High adrenaline levels in our brain are a direct consequence of prolonged heavy drinking and adrenaline makes us alert. Our minds churn incessantly and this keeps us awake at night. This is completely normal, and will come right after a couple of week or so but it leaves us feeling tired and prone to feeling sorry for ourselves. As soon as the brain figures out how much adrenaline to release (now that alcohol’s not slowing it down every day) then sleep will return and energy levels will come back.
Of the four; Hungry, Angry, Lonely and Tired, it is “Lonely” that causes the most problems. Feeling lonely brings with it a loss of inner strength. But loneliness does not just reduce resolve, it is far worse; it brings on doubt and it triggers cravings.
When we are alone we retreat into our own minds and this is when all our unresolved issues come flooding back in. Dwelling on them causes distress, and that triggers cravings. It’s that simple. It is both simple and inevitable.
The other great issue with time alone is all the doubts our minds start to present. These are all lies constructed within our own minds to try and secure alcohol. The slightest inspection of them shows them to be lies, but they feel very convincing at the time. “I’ve done well, I deserve one”, “maybe I can manage just one drink”, “no-one will know”, “I can’t do this”, “forever! I can’t do forever, I may as well have one now”, “it’s not worth it”. They are all false, but these lies will still come. Know that they are coming and kick them away when they arrive.
You cannot avoid cravings; it is your brain demanding that you find and drink alcohol… that is the very purpose of a craving. The cravings will continue until the brain learns that no matter how vigorously it insists, alcohol does not follow; but it never completely learns this. What it learns is that demanding alcohol doesn’t work as often as it used to, so it diminishes the importance in acquiring it, and that means that the craving is also diminished. But when we first stop drinking the cravings come so close to each other that they seem virtually continuous; the fight is constant.
There are medicines available that will reduce craving and if you haven’t been to visit a doctor before then it’s worth doing so now. A doctor’s visit will achieve several things; it lets somebody else know that you have recognised that you have a problem and are going to try to stop drinking. This stops it being a secret. The doctor may be able to prescribe medication that will help with the cravings, and they may be able to suggest or refer you to other support channels. At the very lease you will feel as though you’ve done something to help yourself. All will help, but in particular the medication, and the act of taking it, will help you get past the early cravings.
We must confront and overcome cravings; that is how we make them decline. But when they come one after another, relentless and ferocious, then then can wear down our ability to fight back. If we can do everything at our disposal to keep resolve high, and if we can spread the cravings out so that we get time to recover, then we greatly improve our chances of getting through.
In the early days of recovery we need to take extreme measures if necessary to reduce the pace that we get hit by cravings. Some are completely unavoidable, but some are not. There are many things in our daily routines that will initiate cravings, and we can temporarily change our routines, drastically if necessary, to avoid them.
There will be certain places that are guaranteed to bring on powerful cravings. These are places that we used to drink, and places that sell alcohol; bars, restaurants and stores.
Avoid them all.
Do not expect to be able to get sober if you walk into a bar every day after work… it’s not going to happen. Do not expect to be able to resist buying alcohol if you walk into an alcohol shop (or even park outside it); you won’t. Do not expect to be able to leave alcohol in the bottle if you have some at home; you won’t.
You don’t have to avoid these things for the rest of your life, but you do need to avoid them until you are able to manage the cravings that will come with them. In time you will be able to go into places where alcohol is available and retain proper free-will; you will be able to choose to not drink; but that time is later. You need the cravings to subside to a level that you are confident that you can manage them before any of these things is possible. Before you reach that state you need to keep the cravings spaced out enough that you have the strength to confront them when they come. If this means becoming a social hermit for a while, then so be it. This is what will allow you to live freely in a world awash in alcohol later on… but that’s not now. Right now you need some space between cravings to keep your resolve up.
Not all cravings can, or should, be avoided. We take the power out of cravings by not giving in to them, so we need to confront cravings in order to make them diminish… but they are not in short supply. Even if we drastically change our routines the craving are still going to come charging in. When they come we have three main tools; Delay, Distract, and Deny.
Cravings are cyclical. If we can delay acting on them then their peak will pass and we will regain control. When a big craving comes you need to buy yourself some time. DO SOMETHING. Don’t just sit there and endure it waiting for it to pass, do something to make it pass. Do anything at all, it doesn’t matter what it is, but do something that will occupy you for a while; do some housework, tidy something, build something, cook something, re-arrange something, clean something, go somewhere, go for a walk, jog, swim, write something, call someone… absolutely anything will do in these moments but do something. Do something that will fully occupy you through the minutes of the peak of the craving and it will have faded by the time you are done; you will have control back. If people have said “call me if you get into trouble” then now is the time they were talking about. If you have some numbers then make the calls; this is why you were given them.
Big cravings are inevitable and it is well worth taking the time to prepare for when they come. Prepare some things that you can do that will occupy your mind and hands so that they are ‘ready to roll’ when you need them.
If our mind is fully occupied doing something else then a craving cannot grow; being engrossed in something that requires our full concentration achieves this. But the opposite is also true: If our brains have spare capacity then they are going to fill with thoughts that initiate cravings. Time alone is when we are most exposed to this.
There are two distinct challenges here. The first is to avoid time alone with nothing to occupy our thoughts, and the second is to force cravings away when they come to prevent them growing.
We need to minimise unoccupied time alone as this is time that’s guaranteed to cause trouble. The most difficult times of all are the times of the day or week that we would usually be drinking. If we plan to fill this time doing something productive then we not only reduce the cravings that are guaranteed to come (they are triggered by the time of the day as well as the locations) we also lift our self-esteem… and we desperately need that. Any activity that is not associated with drinking is good; exercise, sport, learning something new, a project of some sort, or, best of all some sort of community service. The value of using this time to do something that contributes to society is enormous. It not only helps reduce the cravings it also increases our sense of worthiness, and we are in sore need of feeling good about ourselves. Any sort of community or animal welfare activity will achieve this, so if you have ever considered doing some voluntary service, then now is a really good time to do so. If you haven’t considered it before then now is a good time to give it some serious thought. It will help you far more that you expect.
Even when we have planned to be in company for as much time as we can it is inevitable that there will still be some times that we are alone. Prepare in advance for this time. Identify a range of things and have them all ready-to-go for when you need them. They need to be tasks that will fully occupy your mind and keep you busy for about 15 minutes or more. By then the peak of the craving will have passed.
This is the back-stop. If we lack the means to acquire alcohol, then even if we can’t beat the cravings we can still avoid acting on them. Do things that will prevent you being able to buy drink even if you want to.
- Don’t have alcohol in the house
- Don’t be alone without being accountable for where you go and for how long you will be away (arrange to call people)
- Don’t carry cash
- Don’t sit in bars
- Don’t go near places that sell alcohol
- If you are out, then have someone with you that knows they must stop you drinking
Assume it will happen; that you will be confronted by a craving of such intensity that you want to drink. Plan in advance to deny yourself the opportunity to drink in that moment. You will thank yourself for it later.
Step up the plan
When we relapse it’s time to take stock of where we are; whatever we were doing… it wasn’t enough. The challenge in these early days is immense, and at first we underestimate it. We need to bring more armour and more weapons into the fight.
Have a look at the preventative steps you were taking up to the relapse. Were there things you could have done to improve your chances? There’s a wide range of suggestions here… how many of them were you using? It is probably time to beef up the defences.
Were you doing things to protect and replenish your resolve? And were you exposing yourself to avoidable risk?
The other aspect to look at now the amount of external help you were drawing on. We can’t do this entirely alone. We are armed with willpower and logic, but our addiction also has the primal power of the cravings. These are intense, unrelenting and impervious to reason, whereas our willpower is finite. We cannot expect to overcome the height of these initial cravings entirely alone, it is more than our equal, we need an external boost. If we continue to fall at this initial stage then perhaps we need to add some more people to our team.
- Did you involve your doctor in this effort? Were there services recommended that you didn’t take up? Was there medication to help with the cravings offered? Did you take it up?
- Who do you have on your team? Do you have someone close you can call when things get tough? Is there a recovered alcoholic you can talk to? Are you regularly connected to a recovery group of some sort?
If you are failing repeatedly in this first stage then it may be time to consider residential treatment. If you simply cannot get past the intensity of the cravings that happen in the first 30 days or so then perhaps you need to put yourself where there is no access to alcohol at all. Is it time to consider some formal treatment, a counsellor or treatment centre?
Once the cravings aren’t continuous
In the early days of becoming alcohol-free we need to work on the things that will sustain and replenish our resolve; understanding the individual triggers really makes little difference in this phase since simply being awake is sufficient to bring on a craving. But later on we experience the effect of individual triggers quite distinctly, and they can be identified more easily.
We don’t suddenly change into a person that no longer drinks; whether we like it or not our automatic brain still wants to. While we may have reached a rational conclusion that this is the course that we must take, the automatic processes in our brains still insist that we find and consume alcohol. Those automatic processes can’t be forgotten, and they can’t be turned off. Most definitely they can’t be ignored… they come without our bidding and they are powered by direct changes in brain chemistry that can’t be negotiated with; they are impervious to reason.
Our sobriety begins as something that is incredibly fragile; it can fracture at any moment. But over time it becomes more resilient and robust. Whereas initially we may have needed to avoid a lot of social contact simply because there would be drinking there, we need return to the world at some point. This means exposing ourselves to triggers that are still fully powered up. We can’t avoid all triggers for the rest of our lives, indeed we don’t want to. We want the triggers to become impotent so that we can move freely around the world like everyone else does. This means that we must expose ourselves to these triggers, and overcome them. The great danger here is that our sobriety is not yet robust enough to beat them, and we fall.
Relapse in this period is very different. In the early stages of going without alcohol the effort was continuous; we had to be constantly vigilant and ready to fend off the cravings as they came. Relapse in this later phase is usually attributed to becoming complacent, but that’s not really what has happened. What’s happened is that the nature of the problem has changed. We no longer need to live on endless high-alert because the constant onslaught of cravings has stopped. So we stop living constantly on edge and in fear of picking up a drink; that challenge has mostly disappeared. Yes, there is still a fairly constant pull towards drink, but its ferocity is diminished and it becomes manageable. It is still there, but it is not debilitating; so we can carry on our lives no longer looking for it.
The problem has changed from being constant and urgent, to a background rumble with occasion intense spike of craving. The issue in this second period is the triggers that get activated that have not yet been de-powered. These come apparently out-of-the-blue, they come with remarkable ferocity, and we are not prepared for them when they strike. If we relapse in this second stage of sobriety, falling to a sudden or unexpected craving, then we need to inspect the occurrence carefully so that we can recognise it and pan to beat or avoid it next time.
We need to overcome triggers to de-power them. But we also need to avoid falling to a trigger because our sobriety is not yet robust enough to overcome it. We can foresee many of these occasions this can happen, and we can plan for them.
If you relapse in this later phase then have a good look at the circumstance. Can you identify the trigger? Was it a person? a place? a time of the day or week? Was it an event? If you can identify the trigger then you can pre-arm yourself for the next time it is activated. You can be ready to meet the craving as it comes instead of being ambushed by it. You can prepare to move away from the circumstance if you feel it is starting to overwhelm you, or you can avoid exposing yourself to the trigger altogether.
The triggers that challenge us in this phase fall into two groups: triggers invoked by the circumstances around us, and triggers we initiate ourselves.
External triggers are circumstances that will induce a craving when they are directly perceived. The simplest and most basic trigger that will induce a craving is seeing alcohol; this will automatically induce a powerful urge to pick it up and drink it. Alcohol is everywhere, either directly or in imagery (advertising, movies, television etc.), so it is a trigger that is activated on a very, very regular basis. But the craving induced isn’t always of the same intensity; it depends on how close the source is and for how long.
The closer we are to alcohol then the more powerfully we are encouraged to seize it. This isn’t a simple linear relationship; it is exponential. As we get closer to alcohol then we are far, far more motivated to take it. The craving is far more insistent when alcohol is close. Furthermore, if alcohol is present for an extended period then the craving keeps getting fired and it builds on its own intensity.
If alcohol is an hour’s journey away then it has little pull, if it is in a nearby building then it is calling, if it is in the same room then it is an insistent demand, but if it is within reach then the demand to pick it up is almost overwhelming. This is why it is extremely difficult to get sober while there’s still drink in the house. But even if there alcohol is not physically close, we still see it everywhere… in billboards, adverts, TV movies etc. The trigger of being close to alcohol is fired many times every day. It is one we cannot escape from without entirely removing ourselves from society.
In time this trigger loses its intensity and we become able to tolerate being close to alcohol far better, but that takes months rather than days, or weeks, and while this trigger may diminish in power it never goes away completely.
The others triggers are mostly social. There are certain times of the day, times of the week and occasions that we routinely drank; e.g. on the way home from work, weekends, sports events, social outings etc.
Drinking triggered by a certain time of day, or day of the week can be dealt with by a substantial change of routine. If we continue to go to the places that we used to drink then it is virtually inevitable that we will drink again; alcohol is close, and it is close for an extended period. We have to find an alternative.
That time was wasted; now we can do something substantial with it. If we can identify what day(s) and time(s) are habitually associated with drinking then we can plan alternate activities to fill those times. It may be a good opportunity to get routine exercise, or we could devote this time to a new project or passion; like making something, learning a new skill, or contributing to the community. Anything that fills this time in some way, and that is constructive and worthwhile, will remove this trigger’s power.
Social occasions where drink will be present are virtually unavoidable, and avoiding these completely and forever will deny us of very many opportunities to enjoy life, so we need to be able to attend these functions. But we need to know that these events will trigger cravings that will be intense until they have been left un-satisfied many times.
The best preparation for all of these it is to re-enter the social world in a controlled manner. At first we should simply avoid these occasions; there are plenty of other triggers sapping our resolve in the early days of recovery without adding more. Missing a few occasions is not the end of the world; it is preparation for re-joining the world successfully. When we have more control of our sobriety then we can go to events like this without concern, but initially there is great risk. We should deliberately have a ‘minder’ with us on these occasions; someone who knows that we must not drink and will intervene for us if we’re not able to do so for ourselves. The next step is to go alone, but still be accountable to someone for our actions. I.e. have prepared in advance some time(s) at which we will ‘report in’ to confirm that we’ve participated in the occasion, but not drunk.
The most important thing about these occasions is that we must be able to leave if we need to. If the demand to drink gets too uncomfortable then we need to go. As the distance between us and alcohol increases, the craving diminishes in power. We may need to step away for a short time to rebuild resolve, or we may need to leave completely. Either way, we must be able to move away if we need to or risk being overwhelmed. Knowing that we are not trapped is often enough for us to be able tolerate the discomfort of the craving in favour of remaining at the occasion, but we will not want to linger. Instead of being the last person to want to leave a party we become among the first.
While all cravings are triggered by something specific, not all triggers are brought on by the outside world; there are some that we conjure up all by ourselves. Some of these are entirely automatic and beyond our control, but others are summoned.
Alcoholics have two powerful triggers that are general in their nature: if we are feeling down, and if we are feeling anxious or distressed. These are the triggers that trapped us into the feedback loop of addiction, and both of these triggers start firing constantly when we first stop drinking.
Heavy drinking over an extended period causes a reduction in the amount of ambient dopamine in our brain. Among other things dopamine is responsible for making us feel happy, so when we first stop drinking we are unhappy. There is nothing to be done to change this; it is a consequence of altered brain chemistry. We might rationalise this in many ways; e.g. we’re ‘grieving’ for our loss of alcohol, we’re missing out on life’s good times etc., but the simple fact is that we are going to be unhappy until our brains naturally re-adjust the dopamine level.
The second group of triggers are fired by our imagination. We don’t need to see alcohol to be triggered to want it, imagining alcohol will do the exactly same thing. Similarly, if we daydream ourselves into distress, then we will initiate a craving in response to the anxiety.
Time alone is particularly difficult for us. This is when we dwell on our problems, and when we do that we make ourselves distressed and we trigger cravings. This is why it’s so important to try to initially reduce the time we spend alone and to take time to come up with things we can do that will fully occupy our minds; things that require concentration. If we feel unhappy then we crave alcohol, and if we are distressed we crave alcohol. These cravings are completely automatic and beyond our direct control. We will often induce both of these state ourselves when we dwell on the past. And we do this most often when we are alone and not fully occupied. While we are building our resilience to cravings we need to minimise these extra burdens and stay in the present. Dwelling on the past will invoke emotions that then trigger more cravings, and we need to avoid doing that. If you catch yourself dwelling on the past then remind yourself that it’s OK to look at the past, but don’t stare; that is when you are building an emotional response to the thoughts. When it happens do something to deliberately change your line of thinking. If it’s hard to shake off then pick up one of the “do something” tricks you have prepared.
Learn and move on
Understanding some things about our triggers can be helpful, but it is only a limited benefit because completely avoiding the triggering circumstances is not a solution. In order for cravings to subside they have to be triggered and then overcome. Knowing our triggers is useful insofar as we can know when to expect that cravings will come, and therefore be prepared to face them. But we live in a world awash in alcohol, and alcohol references are everywhere; in advertising, movies, TV etc. We can’t wrap ourselves up and stay away from all alcohol signals for the rest of our lives; this is both impossible and counter-productive. We have to come to terms with living in a world where alcohol and references to alcohol are commonplace. Shielding ourselves completely from triggering events does not help us in the long run. We have to overcome them to diminish their power. Once that is done we can again pass freely through the world.
This is the great issue regarding relapse; we have to keep exposing ourselves to triggering events. What we don’t know is whether or not our resolve is sufficient to meet the challenge, or if it is too depleted, and we don’t know if the craving will be so severe that our sobriety is not yet resilient enough to overcome it. Not only is the limit of our ability to withstand cravings a moving boundary, it is also invisible. We don’t know whether we are up to each challenge until we actually meet it, and sometimes we are not. We only discover this when we are tested, and the challenge turns out to be too great. We relapse and are immediately plunged into a well of despair. But it is nothing like as bad as it feels.
It doesn’t seem like it immediately, but at the end of the day all relapse is growth. The good sober time before the relapse is proof that you can do this. Those days are not taken away by drinking again. They are proof to you that the task isn’t impossible… because you’ve already done it before. The relapse into drinking also teaches us two more things; that the problem is still there… we didn’t become cured by not drinking, and that there is a boundary to our ability to reject drink. We know the position of that boundary now. In time that boundary will move further and further out, but this time we have over-stepped it. Next time we meet it we can have guarded our reserves of resolve better, and we can take steps to manage the risk better, but only if we stop to learn from the experience. ‘Did I do the things that would keep my resolve high?’ and ‘Did I do things that placed me in risk beyond my ability to manage it?’ are the key questions. When we relapse we need to ask ourselves these questions and modify our behaviour accordingly. That is where our growth comes from.
Nothing is lost in a relapse, but much can be gained if it is sought out. Picking up a drink may set our count of “sober days” back to the start, but we are not back at the start of our recovery.
Recovery is not taken away by relapse; nothing is taken away. If we are able to learn from the experience then not only is our recovery still intact, it is advanced.
It is time to stand up again and step back onto the pathway that leads to a future free of alcohol, to a future without the shame, guilt, fear and loneliness it brings. You know the road is rough, but step forward anyway. You are stronger and wiser now than you were before. Step forward, and then step again. At every step you take you move further from misery and suffering and you get closer to a life that’s contented and free. You deserve that; go and get it.