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Substance Abuse: Growing Beyond 12 Step Program Dependency
10 CEUs Substance Abuse: Growing Beyond 12 Step Program Dependency

Section 8
Addiction Relapse

CEU Question 8 | CEU Test | Table of Contents | Addictions CEU Courses
Counselor CEUs, Psychologist CEs, Social Worker CEUs, MFT CEUs

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On the last track, we discussed the importance of an addict taking risks in a relationship and the three main risks that an addict will need to face.

On this track, we will be discussing the three main causes of relapse in addicts, which I have found are: leaving a recovery programs prematurely, "dry drunk" behavior, and a lack of self-trust.  Do you agree?  Or do you have three others?

I have noticed, probably like you, that many clients in recovery programs find that they must work through the program more than once to reach recovery. Beth, age 32 is a good example. Beth, recovering from an addiction to heroin, was considering working full time at a flower shop.

She had had a number of experiences with relapse but felt that she was recovered enough to change jobs from working 20 hours a week bagging groceries to 40 hours a week arranging flowers. You can probably guess what happened. As the floral job took more time and had more responsibility, it added to Beth’s stress. This caused her to stop going to her 12-Step meetings. 

Three Common Causes of Relapse

Let’s analyze the three most common causes of relapse. As I read through the list, think of your Beth.

Cause #1 - Decision to Leave Recovery Program Early
The first common cause of relapse that I have found is an addict’s decision to leave a recovery program early or before they are ready. Often they either approach the recovery program with a "quick-fix" mentality or, as in Beth’s case, they are in denial about the size of the problem. How many quick-fixers are you currently treating that are in denial?

Because Beth never reached the later steps of the program, based on my experience, with other clients, I feel she may have increased the chance that she would have a relapse. Her denial regarding the all-encompassing nature of her heroin addiction had caused her to think she was cured before she had completed each step.

As you can probably guess, after four weeks, Beth had returned to her heroin addiction. She stated, "I realized I was just looking for a quick solution to a problem I didn’t think was that serious."

Cause #2 - A 'Dry Drunk'
The second common cause of relapse I have found is an addict who has become a "dry drunk." As you know, a dry drunk is an addict who has stopped the addictive behavior and is no longer chemically dependent but is not recovering from the addictive process and the unhealthy attitudes that created that process.

Some traits of a dry drunk that Beth exhibited were: grandiosity, judgmentalism, intolerance, impulsivity, indecisiveness, dishonesty, controlling, and self-centeredness. Sound like a client of yours? Beth stated, "I just wanted to be able to say I wasn’t addicted anymore. I was in recovery, but the problem was I still acted like I was addicted."

Cause #3 - Lack of Self-Trust or Self-Confidence
In addition to leaving the recovery program early and a dry drunk, the third cause of relapse I have found is a lack of self-trust or self-confidence. It is this lack of self-trust that causes recovering addicts to state that recovery is forever. Some, addicts, like Beth, feel that they no longer need group support once they’ve reached the 12th step.

However, when they stop using the group for support prematurely, they may begin to feel guilt and insecurity without the group’s encouragement. This guilt for not attending meetings is often cause for a relapse. Thus a paradox is created where the help agent actually increases the likelihood of relapse due to guilt trips laid on members with spotty attendance.

Beth stated, "I felt guilty and afraid of relapse. After I stopped going to meetings, my friends from those meetings started telling me that I was making a big mistake and I needed to come back to the meetings. But then they stopped calling entirely! They doubt my ability to work at the flower shop and stay clean and sober without the group. I started overeating and binging and thought this is the first step starting back using heroin again."

For Beth, her situation could be looked at from two different points of view, depending on your philosophy regarding 12-step versus rational recovery. Either
1. Beth needed to realize she could be independent and autonomous without her group to dispel her guilt for not attending meetings which she stated was leading her to use. Or
2. a 12-step focus would state Beth needs to conclude that the meetings do keep her sober and she does need to continue to attend.

'Ready to Leave Treatment' Exercise

Thus, according to the 12 steppers the concept of group members guilt-tripping her is just a symptom of her dry drunk behaviors of grandiosity, judgementalism, intolerance, impulsivity, indecisiveness, dishonesty, controlling, and self-centeredness. I felt the  "Ready to Leave Treatment" exercise might be beneficial.

For the "Ready to Leave Treatment" exercise, I gave Beth the following list of questions:

-- 1. Have you identified and admitted your addictive behavior?
-- 2. Have you maintained sobriety for six moths to a year without relapse?
-- 3. Have you completed the steps to a recovery program at least once?
-- 4. Have you learned to recognize and handle successfully the triggers and mechanisms that set off your addictive behavior?
-- 5. Have you shared your story repeatedly with others, and listened to theirs?
-- 6. Are you able to rely on others for support and ask for help when you need it?
-- 7. Have you had a successful relationship with a sponsor, buddy, or other support person for a significant time?
-- 8. Have you severed or limited all relationships with people who supported your addiction unless they are also fully in recovery?
-- 9. Can you say no when tempted or pressured?
-- 10. Do you know the difference between instant and deferred gratification, and can you choose intelligently between them?
-- 11. Can you act on thoughtful decisions instead of impulsively reacting to events and circumstances?
-- 12. Do you have a clear sense of who you are and what your goals are?

I told her, "You are only allowed to use yes and no answers. ‘Maybes,’ ‘sort ofs,’ and ‘I don’t knows’ don’t count." Once she answered all 12 questions with no gray "maybes" or "sort ofs", the majority of her answers were no. I asked Beth, "Are you sure you no longer need treatment?" Beth looked uncertain and said, "I don’t know."

I told her that ultimately, of course,  it was her decision, but that she could consider some options, such as a support group that met at a different time with different people, if she felt at odds with the current group she was attending. I explained to her each group has a personality.  Beth considered the options, and decided to try attending a support group at a different time, location, and day of the week.

Do you have a client like Beth who is struggling with the possibility of relapse? Has he or she been in and out of  recovery before? If so, would doing the "Ready  to Leave Treatment" 12 questions help him or her?  Would it be appropriate to play this track during you next session?

On this track we have talked about three main causes I have observed regarding relapse in addicts.  These causes from relapse are leaving recovery programs prematurely, "dry drunk" behavior, and a lack of self-trust.

On the next track, we will discuss the Dream of Dependency and the three reasons addicts have this dream. The three reasons for the addict’s Dream of Dependency are that their parents led them to believe someone would take care of them as adults, that their parents failed to teach them the skills necessary to take care of themselves, and that they never learned to feel capable of being responsible for themselves.

- Streifel, C., & Servaty-Seib, H. L. (Jun 2009). Recovering From Alcohol and Other Drug Dependency: Loss and Spirituality in a 12-Step Context. Alcoholism Treatment Quarterly, 27(2), 184.

Peer-Reviewed Journal Article References:
“Evaluating autonomy, beneficence, and justice with substance-using populations: Implications for clinical research participation”: Correction to Strickland and Stoops (2018) (2018). Psychology of Addictive Behaviors, 32(6), 678. 

Field, M., Heather, N., Murphy, J. G., Stafford, T., Tucker, J. A., & Witkiewitz, K. (2020). Recovery from addiction: Behavioral economics and value-based decision making. Psychology of Addictive Behaviors, 34(1), 182–193.

Kang, D., Fairbairn, C. E., & Ariss, T. A. (2019). A meta-analysis of the effect of substance use interventions on emotion outcomes. Journal of Consulting and Clinical Psychology, 87(12), 1106–1123. 

Redish, A. D., Jensen, S., Johnson, A., & Kurth-Nelson, Z. (2007). Reconciling reinforcement learning models with behavioral extinction and renewal: Implications for addiction, relapse, and problem gambling. Psychological Review, 114(3), 784–805.

Vallejo, Z., & Amaro, H. (2009). Adaptation of mindfulness-based stress reduction program for addiction relapse prevention. The Humanistic Psychologist, 37(2), 192–206.

Witkiewitz, K., Lustyk, M. K. B., & Bowen, S. (2013). Retraining the addicted brain: A review of hypothesized neurobiological mechanisms of mindfulness-based relapse prevention. Psychology of Addictive Behaviors, 27(2), 351–365. 

Online Continuing Education QUESTION 8
What can be  three main causes of relapse in addicts? To select and enter your answer go to CEU Test.

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