Relapse, relapse, relapse. Every day you read about someone with an addiction who has relapsed. Given the chaos and misery this causes for addicts and their families, I sought out Dr. Gregory L. Jantz, Ph.D., C.E.D.S., founder of The Center, A Place of Hope, and posed this challenge to him: can you name the top 10 cracks that crack addicts (and other addicts) fall through?
Here is a list based on his ideas, and I'd recommend that anyone who struggles with addiction print it up and keep in a place you can see it, "one day at a time":
- Failure to develop new and healthy relationships. An addiction is a routine, and old and unhealthy relationship are unhealthy routines that can lead to relapse, just as new and healthy relationships can help maintain healthy routines.
- Lack of accountability in general. The more you value keeping your word and following through, the easier it is to stay sober. This often takes several months for the newfound trust and respect from others to sink in and begin to be as satisfying as the addiction is gratifying.
- Maintaining a relationship with a co-addict or codependent. Water seeks its own level. Need we say any more?
- Trading addictions. If you think something along the lines of, "I no longer drink so binging on food is OK," you're unaware of this "addiction dance." Unless you replace the unhealthy habit with a healthy one, and until that healthy one begins to ease the pain that the addiction does, a cross addiction will just be a false recovery.
- Lack of self care, such as poor diet and lack of physical activity. Eating poorly and not exercising can produce sub-clinical depression, and sub-clinical depression can increase cravings.
- Thrill-seeking activity to replace the "high" (i.e., trying to mood-alter). The thrill of an adrenaline rush, which can make you feel powerful, is very seductive when you're feeling lost and powerless.
- Dishonesty in any area of life. Deception breeds denial, which triggers relapse. Doing small things is the way you do big things. A little lying can lead to a lot of lying, and when that happens, denial is just around the corner.
- Failure to have a relapse plan when faced with the strong desire to use. Failing to plan is planning to fail. Without a plan that you're committed to, you are more vulnerable to going back to a "pleasure pain" approach to life.
- Self-deception: Lying to yourself and saying, "Just this one time; that will be the last." Denial is like a welcome mat to using again, and when you take that first drink or hit, the crash from self-deception into using can cause shame that is so painful that the need to now ease that pain can lead to further using.
- Failure to develop meaningful life goals. Believing that your life is meaningless can cause you to feel that it is pointless. And once you feel that your life is pointless, there appears to be no good reason to deprive yourself of the pleasure of drugs. One of the best ways to counter this is to conduct yourself so that people you hurt and disappointed will now trust, have confidence in and respect you. That can cross over into your having respect for yourself, and that can become something so important and meaningful that you wouldn't want to do anything to mess it up.
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I like the play on words regarding "cracks." An anatomy of a relapse. In my experience working with stimulant addicts is often the hardest. The letdown after they stop using feels like an intense depression. To a sane and clear-headed person the top ten list looks obvious. To a freshly-off-cocaine person the challenges seem immense.
I would boil it down even further. The three ingredients to successful emergence from addiction are education, community and accountability. Many addicts are unaware they have a biological problem. They think is it something else (spouse, job, friends, vodka instead of beer, crack instead of coke, etc).
As you have described in 1-3, 7 & 8 above, having healthy relationships is essential. Human beings are pack animals and we need each other for survival and health. Finally, accountability is key.
In the beginning it is accountability to others in your support circle (peers, friends, family, counselors, doctors, clergy) but eventually you must be accountable to yourself and to your ideals.
Thanks for the thought provoking article.
Warm regards,
Jason Giles MD
Addiction Medicine