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Relapse Warning Signs Identification

1. What is a relapse warning sign?
A relapse warning sign is any experience that increases the risk of relapse.

2.How is a warning sign different from a high-risk situation?
A high-risk situation is any experience that activates the urge to use alcohol or drugs in spite of a commitment not to. A relapse warning sign is any experience that increases the risk of relapse.

All high-risk situations are relapse warnings, but not all relapse warning signs are high-risk situations.

Relapse warning signs represent a broad category of internal and external problems that link together to lead from recovery to relapse. High-risk situations usually occur immediately before people relapse to alcohol to drug use.

There are relapse warning signs (i.e. experiences that increase the risk of relapse) that increase stress and cause life problems but don't directly create an urge to drink or use drugs. These "early stage" warning signs lower people's resistence so they are more vulnerable to high-risk situations that cause craving.

Relapse warning signs can also be internal. Certain ways of thinking and feeling which are not observable to others can be very serious relapse warning signs. High-risk situations, on the other hand, are external events that can be observed by others.

3. Whats is a relapse warning sign list?
A relapse warning sign list is a progression of related warning signs that lead from stable recovery to relapse.

4. Are there certain ways in which warning signs develop?
Yes. Although there are many different possible warning sign progressions, there are certain rules that seem to govern the development of relapse warning signs. These rules can be useful when helping clients to clarify their final warning sign list, especially when looking for hidden warning signs, backtracking to early warning signs, and identifying the late stage warning signs that directly precede alcohol and drug use.

Progression: Relapse warning signs usuallly progress from a minor experience that caused low level pain and problems to major experiences that cause intense or high level pain or problems.
Relapse warning signs tend to begin with a relatively minor experience that causes low intensity pain or minor problems. This experience is mismanaged in a way that creates the next warning that causes more severe pain or problems.
Relapse warning signs are usually connected. In other words, the first warning sign is mismanaged in a way that causes the second warning sign. The second warning sign is mismanaged in a way that causes the third and so on.
Here's how this process works:
The warning signs cause pain (I hurt): and problems (things start to go wrong);

I try to manage the pain by doing something to make the pain go away;

I try to solve the problems by doing something to make them go away;

I use coping strategies that don't work. In other words, the things I do to make the pain go away causes the pain to get worse and the things I do to make the problems go away create bigger and more complicated problems;

These new problems become the next warning sign in the progression and the cycle starts again.

Stress: As the warning signs progress and become more severe, the client's level of chronic and persistent stress begins to go up. The client begins to live in a chronic state of low-grade emergency.
Dysfunction: This state of chronic high-stress and constant low-grade emergency causes impaired judgement and poor impulse control, which creates even more dysfunction.
Self Defeating Personality Traits: (Anger, distrust, dishonesty, etc.). Eventually, the stress becomes so severe that old self-defeating personality traits (deeply entrenched habits of thinking, feeling, acting, are related to other) are activated.
Return of Old Beliefs: When the self-defeating personality traits are activated the person starts using there old belief system that limits their perceived options and then to create even more severe problems. This belief system represents "the truth as I see it". The person looses the ability to see himself or herself, other people, or the world in any way exept as defined by the old belief system. At this point, it becomes very difficult to reason with the person because they actually forgot or lose touch with any other way to think about or perceive things.
Loss of Control: The person eventually loses their perspective and begins a series of impulsive reactions that render them out of control of their thoughts and behaviors. They get into a frenzy of irrational behavior that causes a series of progressive more self-defeating behavior. This progression of behavior gains momentum and seems to take on a life of its own.
Lifestyle Problems: At each step of this progression the self-defeating personality traits create new and more severe lifestyle problems. The lifestyle problems intensify the stress and the cycle of self-destruction continues.
Addictive Thinking: When the pain and problems become severe enough, addictive thinking and behaviors get activated. The addictive thinking tells the person that alcohol or drugs can help them to cope with the pain and problems. The addictive thoughts are accompanied by selective and usually distorted memories of past experiences where alcohol and drugs helped in similar situations.
Addictive Behaviors: These addictive thoughts and behaviors cause the person to get involved in high-risk situations that create the immediate risk of using alcohol and drugs.
5. Helping people to identify their warning sign progression.
There are two methods for identifying relapse warning signs that put a person at risk of moving from stable recovery to relapse. These methods are:
Exploring Relapse Warning Signs: Identify the progression of problems or situations that lead you from stable recovery to relapse. (This teaches one to critically review the past and learn from it). Also identify the sequence of problems that you may experience in the future that may/will cause you to relapse (this teaches the skill of anticipating future problems and situations).

Reading the Relapse Warning Sign List: Use your Relapse Warning Sign List as a tool to help you to clarify the high-risk situation that was selected. Read your Relapse Warning Sign List out loud and select three warning signs that you identify with. Describe these warning signs in words that are easy to understand and remember.

Both methods are usually used. The key to success is asking and using active listening. Ask yourself: "What kind of things could cause you to move from stable recovery to relapse in the future?" Use active listening and write a title (a bullet statement) for each problem in the initial progression. This will result in a simple two or three step process.
General Patterns of Relapse Warnings That People Tend to Experience
There are a number of different patterns that tend to emerge. Some of these patterns are related to personality style. These are:
1. Top Dog Pattern
I get tired of being told what to do

I stand up for myself

Other people get mad

I wont put up with their stuff

I get away to avoid trouble

I feel mad but there's nothing I can do

I want to get back at them

I start building up like a pressure cooker

There's no way to let off steam

I remember how good it was to drink and drug

2. Under Dog Pattern
I try to work the program

I can't get the kind of help I need

I do the best I can but nothing works out

I feel trapped and helpless

I get depressed

I think about drinking or drugging to help me feel better

3. Ambivalent Pattern
I decide to take charge for my recovery

I start making things happening

I lose my motivation and say who needs this

I back off and want others to do it for me

They won't help me

I take control and start running the show again

I run out of steam and the cycle starts again

4. Detached Pattern
I get bored

Nothing seems very important

I stop working my program

I don't care about anything

Nothing seems to matter

I want to drink or drug because I am bored and don't know what else to do

How is Warning Sign Identification Different From Identifying High-Risk Situations
When identifying high-risk situations you are looking for a single event that causes the urge to use alcohol or drugs. One has to learn how to get through this situation without using alcohol or drugs.
When identifying relapse warning signs you are looking for patterns of related warning signs. You are looking for an inter-connected series of experiences that lead slowly and progressively from stable recovery into a high-risk situation, which activates craving.
With high-risk situations you find a single incident that causes alcohol and drug use. In warning sign identification you find the entire sequence that cause the person to create or get involved in that situation.

source: http://www.focus.bm/warning_signs_identification.html

*Interaction between an imprisoned heroin addict, his mother, and his ex-fiancee/friend*

Prisoner: You two can come pick me up when I get released, but I'm going to pack up a bag and disappear or spend the night in the woods by myself.

Friend: We won't come and pick you up then.

Prisoner: That's fine I have twenty people I can call. I'll have someone pick me up from the side of the road. You can just come bring me clothes and I'll go.

Friend: Oh yeah? Who are you going to call?

Mother: Who even has money on their phone? *chuckles*

Prisoner: The mail is my phone. I'll just write letters and everyone can show up, and I'll pick who I leave with.

Mother: And where are you going to go? What are you planning on doing?

Prisoner: I don't know... go to my friend's house and drink a beer and smoke a joint. If the parole officer doesn't show up by nine p.m., I'm going to assume they're not coming, and I'm going to go out to the bar and do what I want. I'm going to go see some people that I want to see.

Mother: Son, you can't do that.

Prisoner: If I want to have a beer, I'm going to have a beer. If I want to smoke, I'm going to smoke. I'm a trouble maker. I'm not going to get out of here and be some goody two shoes. That's not who I am. I'm going to do some things I shouldn't be doing.

*Mother and friend both slump and look down at the table*

Prisoner: What the fuck is wrong with you guys?

Friend: It's just the things you are saying.

Prisoner: What do you mean?

Friend: The things you're saying are the exact same things that you've said before you were released from Cook County. *starts scratching legs*

Prisoner: What the fuck, you guys are just expecting me to fail? That's great. You know what, fuck it. *throws hands*

Friend: It's not that it's just there's certain things that you say that are like red flags for us, you have to understand that.

Prisoner: What are you talking about?

Mother: Pack a bag. What's going to be in your bag?

Prisoner: I don't know, stuff.

Mother: What do you mean?

Prisoner: I don't know. I don't know what I'm going to do. I don't know what's going to happen.

Mother: What about fishing?

Prisoner: I would love to go fishing.

Mother: Why can't you just say you're going to go fishing?

Prisoner: I'm not going to have TIME to go fishing! I need to find a job.

Mother: I told you I have a number for someone that can help you find a job.

Prisoner: I want things set up before I get out of here.

Mother: I don't know if that can happen, I'm going to try to find you a job before you get out.

Prisoner: I don't even know if I can still stay at my friend's house. I haven't heard from her.

Mother: I'll call her when we leave and tell her to write you.

Friend: Why don't you go back to school?

Prisoner: I need to find a job.

Friend: I know but you can use school to take up some of your free time.

Prisoner: I don't want to build things up just to fuck up and fail again and go back to it. I just want to get out (July 27th) and be free for seven days. After that, I don't fucking care. I was only out for six days last time, I just want to make it seven and it doesn't matter what happens after that.

Friend: At least try and stay out until my birthday (August 16) or even your birthday (October 8).

Prisoner: Your birthday is more realistic.

*friend holds prisoners hands*

The conversation is taking place at a table in a prison in Illinois. The participants are a heroin addict that has been locked up for almost two years straight, his mother, and his friend that he used to be engaged to. They are discussing what is going to happen when he gets released in July. It begins with planning out the first day, who's picking him up, what he needs, and where he's going to go. The mood starts out as half-joking half-serious comments made back and forth between the inmate and his mother and the inmate and his friend. The conversation starts getting serious when the inmate starts saying phrases that trigger alarm in his mother and his friend. He starts saying things like, pack a bag, disappear, fuck it, i don't know what's going to happen, i'm a trouble maker, etc.. An example of an affect display is when the inmate's mother and friend slump and look down at the table simultaneously while he is talking. The conversation turns to the inmate notices the expectancies his mother and his friend feel about what he's saying personally and as though they are assuming he's going to fail. When the friend starts scratching her legs, she is using an adaptor. She is becoming anxious because of the confrontation. He wants to get all of these things set up, but he wants it done before he gets out and it seems with little effort on his part. Then, when given options he rejects them. At the end of the conversation, it turns into the inmate assuming he's going to fail. Through language use, the inmate is displaying different personality patterns linked with relapse. The inmate gets sick of being told what to do and being on a schedule. He feels like he can't get the help that he needs and that he doesn't have the resources. He expresses that he's feeling trapped and helpless because he's in prison and he has no control of what's happening on the outside. He depends on his mother to control what's going to happen and setting things up. He's afraid to start moving forward and succeeding because he's afraid he's going to lose control and relapse and go back to prison. He then expresses that he doesn't care and nothing matters.