How to Identify the Signs of Addiction Relapse.

Pixabay/CC0

Pixabay/CC0

Relapse is the eye of the addiction storm.

Addiction can be a heavy-handed topic, and it’s not always a pleasant conversation to have. But if you’re struggling with reading about it, imagine what it might be like to live with it. Help me spread the word; help others understand it, and help those with it so we can end it. We need to continue to better understand addiction so we know how to stay connected and supportive of those battling it.

In order to further your understanding I’m going to talk about relapse, and even more importantly, I’m going to talk about how to identify several warning signs of relapse.

What is relapse? And when does relapse occur?

Relapse is a process, not a single event. 

It's an addict’s return to the addiction cycle or worse.  Clinically, relapse is the physical act of someone in recovery putting alcohol/drugs into their body. That length of sobriety could have been one day or fifty years but when that substance enters their body the sobriety clock resets. As I said though, relapse is a process and just as anyone in addiction will tell you they didn’t wake up one day and choose to be an addict. No one in recovery just stops and says “today’s the day I return to rock bottom.”  The process can be short and in earlier sobriety it might only be a month or a few weeks but more often it’s slow with several elements occurring subtly over time.

What are the relapse warning signs?

There are several different warning signs but in order to make them easy to remember I want you think of AA. Alcoholics anonymous is most known for its’ ties with helping those in addiction fight for recovery so it’s perfect that the warning signs of future relapse can be broken down into two categories; Attitudes and Actions (AA).

1. Attitudes

One of biggest warning signs I see – especially in early sobriety – is overconfidence. It’s the string of thoughts and sometimes outright statements that imply “I know everything I need to know” and “I can do this on my own.” Don’t get me wrong, having a sense of confidence and pride in what you’ve learned in treatment and/or meetings is powerful (and needed). However, when someone in recovery stops being willing to accept the support, advice or accountability of others there should be some red flags and alarms going off.

Another major warning sign of relapse is when someone in recovery becomes emotionally overloaded. More often than not this occurs as a reaction to an event like a job loss, afamily member passing away or a relationship ending, however medication changes and existing mental illness (like depression or bipolar) can also be a cause. These intense emotional moments will look like an exaggerated departure from the person in recovery’s normal emotional state. This could look like anxiety turning into panic, sadness shifting to grief or anger becoming rage.

2. Actions

One of the biggest warning signs at any point in recovery is Isolation. For any number of reasons, many in addiction put distance between those around them before relapse; this includes family, friends, loved ones, etc. This could be subtle like missing/skipping scheduled meetings or events like lunch dates, support group meetings, or work. It might also be more confrontational like lashing out or manipulating conversation in a manner that makes you feel as if you want/need to leave.

The last major warning sign relates more to inaction than action and can best be described as a general lack of self-care. A few examples of this could be eating poorly, exercising less or not at all, and/or maintaining unhealthy sleeping patterns. You might also notice that the person in recovery has a decreased interest in engaging in the activities or hobbies that you know they enjoy. This is especially important to notice because in addition to being a warning sign of future relapse it could also be an early sign of depression.

What do I do once I've seen the signs of addiction relapse?

Whether you’ve just seen one of them or all of them, you simply reach out. There are several ways to treat addiction but each of them starts with a conversation where you offer your ear and your heart. They might not be ready to share their thoughts or feelings with you at the moment but by keeping the conversation and the support open-ended, they will know they are loved and that someone else is willing to fight Addiction alongside them.

To schedule an appointment with Kendall Campbell, LMFT-Associate, Call 512-920-3654.

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What to do When Trauma Impacts the Ones You Love

Image by Mastercharz on  Flickr

Image by Mastercharz on Flickr

Do you love someone who is dealing with the impact of trauma?

If someone in your life is suffering from trauma, you may be wondering what you're supposed to do. If so, you're in good company. Anyone who has ever loved someone who has dealt with trauma has asked the same question.

Trauma is unique because it has this way of not only affecting the people who've been traumatized, but also those they love. We even have language to describe this: secondary trauma - which captures how partners, spouses, family members and friends can take on symptoms of trauma they didn't directly experience.

So if you've never endured trauma, but someone you love is counting on you for support, this post will help you understand a bit about what they're going through and how to help.

What is trauma?

In it's plainest and most basic description, trauma is a deeply distressing and disturbing experience that has lasting consequences.

Some people differentiate two types of trauma: big "T" trauma and little "t" trauma. Big "T" trauma would be what combat veterans and survivors of assault or abuse experience. Little "t" trauma might describe what it's like to be in a marriage with a neglectful partner. It's unfair to try and classify traumatic experiences, because everyone's different. There's good research to show that even fender benders in which the offending vehicle was traveling less than five miles per hour can have lifelong repercussions.

So no one's trauma should be judged based on what you or I think makes is big "T" or little "t". Instead, I like to think of trauma as any experience that fundamentally changes the way we experience life. I know that leaves a lot of room open for interpretation, but it also holds us accountable to understand our loved ones' experiences rather than rely on our own interpretation of what trauma is.

How does trauma impact the brain?

In my office is a file cabinet. It's a sturdy old thing that came out of WWII. It has a distressed wood foot at the bottom that wraps around the cabinet's cast iron to create a neat contrast. In the file cabinet are files that are neatly ordered by my clients' last names. There's also some odds and ends that I've stored in there because I need access to them and don't have anywhere else to put them.

And this is kind of how the brain works. 

When I need to recall something important, my brain fires off thousands of neurons that interact together to recall memory. Scientists don't yet fully understand how this works, but they seem to think that memory is stored in the hippocampus, available for recall when we need it. So if I asked you what you had for lunch yesterday, it's sort of like me trying to retrieve a file from my cabinet, whose job it is to store ordered information until I need it.

But for those who've experienced trauma, the brain doesn't quite work like a filing cabinet. Instead, it's more like an artist's studio. When you walk inside, you see paintings everywhere, disordered and colorful, overloaded with sensory information. Trying to find a single painting or image inside a studio is difficult. In fact, much like a painting in a studio, a single traumatic memory doesn't make sense until it's brought out of the studio and examined on its own. So when you try to talk to your friend feels triggered by something that reminds her of her trauma, it's her brain flooding her with a stress response to keep that traumatic memory disorganized, so that she doesn't have to relive it. Her symptoms serve a purpose.

Unfortunately, the brain may be working against recovery as Dr. Bessel Van Der Kolk acknowledges in his groundbreaking trauma book, The Body Keeps The Score. Although the brain may be working to keep trauma hidden so that the traumatized person doesn't have to relive the experience, the body still seems to experience trauma symptoms.

This is why people who have been through trauma sometimes have intense and volatile reactions to an environmental trigger (like relationship conflict or a hard day at work) without knowing why. Sometimes, the body remembers trauma before the brain does.

What does trauma feel like?

I once had a client tell me that trauma made her feel like she was walking around with a bomb that no one could see strapped to her back. And at any point, the bomb could explode all over herself and others without any apparent reason. The brain has very interesting ways of protecting us from trauma when we experience it. People will often describe not being able to remember what they felt or the sequence of events that led up the to the traumatic experience. I remember a moment when I played football in middle school and one of my friends snapped his arm in half. He got up and ran off the field, telling coach he was okay and could go back in.

Sometimes, the worst part about trauma is recovery.

Often, the symptoms you would expect people to feel during trauma show up in recovery even though a traumatized person can't remember those symptoms during the actual traumatic moments. The most important thing to know about how trauma impacts your loved one is that it's constantly with him and he can't predict when trauma symptoms will show up. Because of this, much of the recovery process is symptom management.

That means that in counseling, we help people become more and more tolerant of trauma triggers so that they can move forward with allowing their brain to place the trauma memory back in the file cabinet, ordered and meaningful.

You can help your loved one by not reacting to their seemingly out-of-context intense emotional reactions. Simply your willingness to remain calm in the midst of their chaos can be healing.

How does trauma impact relationships?

Most of us have no idea how to help someone who has been traumatized by an experience we've never been through. This is not a shortcoming. It's completely normal. In fact, it's such a normal part of the human experience that we have an entire industry called therapy dedicated to task of "being there" for people who've experienced varying levels of trauma.

So because we're not naturally equipped with the necessary tools to help the ones we love who have experienced trauma, we sometimes pull away from those relationships because we feel powerless to do anything useful. So this creates a feeling of isolation for us and our loved ones. What makes this even more difficult is that depending on the kind of trauma our partner or family member has experienced, their symptoms can make them difficult to empathize with. The real cruelty of trauma is that it sometimes causes quick explosions of anger or long periods of isolation.

So this is why education and empathy are like gold to people who have experienced trauma. Friends and loved ones who are willing to take the time and have the patience necessary to hold space for anger and loneliness are the greatest assets for healing and recovery.

Trauma isn't always something you can see.

Unless trauma has caused physical changes, it isn't like cancer or other illnesses that manifest symptoms you can see or touch. So people don't always know that what their friends are going through because they don't know what to look for. This may even lead to skepticism or misplaced judgment.

A friend of mine is one of the most courageous people I know. She was rear ended and endured a concussion that has had a significant impact on her emotions and relationships. She describes herself as being quicker to anger and, now, situations that weren't difficult in the past feel stressful. You'd never know it by looking at her, and even her close friends only may notice an abrupt mood change. Even if her friends noticed she'd been in a car accident, they may not be able to connect that mood change with her concussion. This has left her feeling lonely at times because no one can see what she's going through.

In order for her behavior to make sense, she has to disclose her trauma.

I don't know if you've ever been sick, but the last thing I want to do when I'm not well is tell everyone how my body is handling the symptoms of illness. It's embarrassing. I'd much rather just stay at home and wait for the symptoms to pass. But trauma doesn't always work that way. Sometimes, trauma symptoms can be resolved in a short amount of time. But sometimes, it takes a lifetime.

So how do I help?

If you love someone who has been traumatized, the best thing you can do is be patient. Gently and carefully remind them that you're there. Don't problem solve. Just be. We have a phrase in psychotherapy called "holding space." I don't usually like therapy jargon, but this phrase I like. It captures what we need from someone when we don't want them to solve our problems, but we do need them to listen.

Some other tips for holding space for the ones you love when they've been traumatized:

  1. Take small decisions off their plate. Strangely, choosing where to eat can turn into a nightmare. Take the initiative for some of the small life stuff and take over.
  2. Don't depend on your traumatized loved one to know what they need. Sometimes, holding space means sitting quietly with your hands open while they cry.
  3. Gently remind them you're there. Send a text message or leave a letter reminding her that you're just a phone call away.
  4. Be patient. Trauma recovery is a long road, and your loved one needs people who will walk through all the ways their symptoms will emerge.

If trauma has impacted your family members, friends or partners, be there for them in their time. It's hard to make sense of the internal studio of the mind long enough to know what to talk about or ask for.

And holding space for someone suffering is a sacred task.

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The Practice ATX

512-861-4131