Recovery from chemical dependence occurs at five levels
– abstinence, situation change, behavior change, emotional change, and
personal belief change.
The first level is abstinence.
Chemical addicts must stop using alcohol and drugs and stabilize
from withdrawal before they can begin to recover.
At this level, we have to make a decision to stop drinking and
drugging and reach out to get help.
Once abstinent, they move into the second level of
recovery that focuses upon situational
change. This level
involves replacing an addiction-centered lifestyle with one that is
To stop drinking and drugging we have to get away from
people places and things that make us want to use alcohol and other
drugs. Counselors call this
“getting into an adequately controlled environment.”
If you keep hanging out with people who are drinking and drugging
your chances of staying abstinence are nearly zero.
To break the cycle of destructive alcohol and drug use you need
help. You need to put
yourself around people, places, and things that will encourage and
support your abstinence and help you to learn a set of specific skills
to keep yourself from drinking and drugging even if you feel like it at
The third level of recovery, is behavior change. Chemical
addicts must learn to identify and interrupt addictive behaviors that
give short term pleasure, create long term pain, and reactivate the urge
use addictively. At this
level, addictive behaviors must be replaced with sobriety-centered
behaviors that produce pain free pleasure by resolving the problems that
create the pain.
Change In Thinking
This leads to a fourth level of recovery, a change in thinking. Addictive
thinking is based upon the irrational belief that addictive use can
magically fix us, solve our problems, and make us something we are not.
We are thinking addictively when we believe that we can never
feel whole, complete, or have the good life unless we are using
addictively. The antidote
for addictively thinking is sober thinking that helps us recognize the
destructive effects of addictive use and see the positive benefits and
opportunities provided by sobriety.
Thinking about using alcohol and other drugs increases
the risk of relapse. Thinking
is a cognitive process controlled by the cerebral cortex or thinking
part of the brain. There
are three ways of thinking about alcohol and drug use that are
The first is called euphoric recall.
You remember and exaggerating the good times that you had when
using alcohol and other drugs while blocking out or minimizing the bad
A recovering person who called himself Jake the Snake
used to tell the story of the great time he had when he got stoned on
cocaine and stole $150,000 worth of coke from his supplier and went off
for a marvelous one week binge in Las Vegas.
He forgot to mention that he caught a serious venereal disease
from a prostitute, and was nearly killed when his supplier showed up to
get his coke back. After
being shot and taken to the emergency room, the police found a small bag
of cocaine and some marijuana in Jake’s room and he ended up in jail
and was serving a seven year sentence when I talked with him.
He still argues that he had a good time.
The second relapse-prone way of thinking is called Awfulizing
Abstinence. You think
about all of the bad times associated with being alcohol and drug free
while blocking out and minimizing all of the good times.
A woman named Jessie told me that nothing was working
out for her since she got sober and she felt shw would be better off to
start drinking and drugging again.
When Jessie was drinking and drugging she was unemployed, earning
money by drug dealing and prostitution, and was in a skid row cubicle
hotel. Now she was physically healthy, working a regular job, and
sharing a decent apartment in a middle class neighborhood with two women
she got to know through her home group of Alcoholics Anonymous (AA).
But in her her mind, at that moment, she felt her sobriety was awful,
terrible, and unbearable.
The third relapse prone way of thinking is called
magical thinking about use. Cognitive
therapists call this positive expectancy.
We start to believe that using alcohol and other drugs will
somehow magically fix out problems and make our lives better. WE forget that alcohol and drugs make us feel good for a
little while and then wipes out our judgment and impulse control setting
us off into a cycle of self-destructive behaviors that destroys us and
those that we love.
People who relapse often begin to spend of their time
cycling between these three ways of relapse prone thinking. They remember drinking and drugging and exaggerate the good
times while refusing to think about any pain or problems. They exaggerate all the pain and problems of living sober
while blocking out any benefits. They
then begin to think about how alcohol and drugs could magically fix them
and make everything in their life wonderful once again. This creates a strong desire to use alcohol and other drugs.
The fifth level of recovery is emotional change. By
turning off our addictive thinking, we turn on our feelings.
Initially this is difficult because we must experience the pain
of the past. The shame,
guilt, and the nagging pain caused by the addiction surface.
There is an urge is to stuff these feelings and run back into
addictive or compulsive behaviors. The permanent way out is to resolve these feelings by
recognizing, labeling, and communicating them to others.
Then we can recognize the underlying thoughts, behaviors, and
situations that create the feelings.
Effective emotional management involves learning a set
of feeling management skills. First,
we must learn how t or recognize the inner experiences that tell us that
we are having a feeling or emotion.
We have to learn to calm down, get centered and pay attention to
the sensations in our bodies. Whenever
we feel tense, have a knot in our stomach, feel queasy, or start
clenching our jaws or fits, or can’t calmly sit still we are probably
having a feeling.
The second feeling management skill is to learn how to
label the feeling with a word or phrase.
This means that we need to develop an emotional volabulary that
will let us think about what we’re feeling on the inside and figure
out how those feelings are connected with what we’re thinking and
what’s happening outside of us.
The third feeling management skill is to talk about our
feeling swith someone who will listen to us, try and understand our
feelings, take us seriously, and respect us.
The best place to find someone like this is at Twelve Step
meetings or by going to a counselor or treatment program.
We can’t manage painful feelings without talking about them. It’s important to talk about our feelings before we try to
block them out by using alcohol or other drugs.
A Change In Core Personal Beliefs
As we learn how to manage pain and unpleasant feelings
we can enter the sixth level of recovery, a
change in core personal beliefs.
Here we confront the core mistaken beliefs about ourselves, other
people, and the world that make us miserable in recovery and make us
want to use alcohol and drugs to block out the pain. These
self-destructive core beliefs were usually developed when we were
children before the age of 10. If
we come from a dysfunctional family, we have probably internalized a
dysfunctional set of core beliefs.
We believe that the world is a painful and difficult place and we
must always struggle in order to survive.
Many of us believe, on a core level, that we a pretty hopeless
and that there is no hope and no way we can ever learn to enjoy life.
These core mistaken beliefs cause us to recreate our
family of origin in sobriety. We
begin to unconsciously set up the situations of our lives to create the
same pain and dysfunction that we experienced as children.
To combat this tendency we must learn to identify these mistaken
and irrational beliefs that we learned as children, to examine the
logical consequences of continuing to believe these things, and to make
appropriate changes in our belief system and our actions.
It is only when we confront our family of origin and learn to be
free from the dysfunctional and irrational beliefs that we can develop
the kind of life in sobriety that will give us meaning and purpose.
The Developmental Sequence Of Recovery
Notice the developmental nature of this recovery
process: (1) stop using alcohol and drugs, (2) replace addiction
centered living with sobriety-centered living, (3) interrupt addictive
and compulsive behaviors, (4) replace addictive thinking with rational
sober thinking, (5) learn to identify and manage feelings and emotions,
and (6) change the self-defeating core beliefs about ourselves, others
and the world that we learned as children.
This model of recovery suggests that relapse is more
than just alcohol an drug use. It
is a process that can occur at each level and progress from one level to
For most people who relapse, the first step is a subtle
return of the core self-defeating beliefs that we learned as children.
Something shifts inside of us and we no longer feel a sense of
self-worth and self-confidence. We
no longer feel worthy of living or having good things in sobriety, or we
no longer feel capable of doing what we need to do in order to feel good
When our old, dysfunctional beliefs from childhood are
reactivated, we begin to have negative feelings. These feelings seem out of place in our newly found recovery.
There is a tendency to repress them.
We would rather not think about them, so we try to push them from
our minds. As a result the pain get worse and we tend to reactivate our
irrational, addictive thinking to cope with the pain.
Our addictive logic tells us we must find something,
anything, that will make the go away.
This urge to blot out the pain awakens the echoes of our
addictive past. We begin to
remember how good it was when we could medicate with alcohol and drugs.
We exaggerate the positive aspects of those memories while
minimizing or denying the negatives.
We then begin to awfulize our sobriety.
We take all the negatives of being sober and exaggerate them,
while blocking out all the positives.
Then, we begin using magical thinking about what alcohol and drug
use could do for us in the future.
The addictive logic goes like this:
"Since alcohol and drugs worked so well for us in the past,
and since it is so terrible to be sober today, alcohol and drugs will
somehow be able to magically fix me in the future."
These irrational thoughts begin to mobilize addictive
behaviors. We begin looking
for something, anything, that will make the pain go away. Since our sober friends are beginning to confront us by
telling us that we are in trouble and we need help, we seek out
"more supportive friends."
We want friends who won't confront us with the fact that we're
backsliding into old behaviors. This
means we begin surrounding ourselves with two types of people -
codependents who won't challenge our self-defeating behavior, and people
who are still actively addicted.
Relapse prevention is both proactive and reactive.
As a proactive strategy, relapse prevention teaches us the
importance of panning our recovery, moving through its various stages,
and recognizing when we become stuck and taking corrective action.
Reactively, relapse prevention teaches us to recognize the warning signs
that show us we are backsliding into previous stages of recovery.
We can then take action to manage those warning signs before we
return to alcohol and drug use.