Behavioral Addiction Relapse

What is a "relapse" in behavioral addiction?

Relapse is considered a full blown return to the destructive behavior. A lapse in a slip are more just temporary return, picking yourself back up rather quickly, getting back on the horse metaphorically and getting back on with life. Where relapse, again, is considered something that ranges anywhere from one or two days, week to many years returning to the disruptive behavior.

What is the difference between a "slip" and relapsing in behavioral addiction?

A slip, or a lapse or relapse, are just terms that we use as professionals to sort of convey the length of time and severity of the fall back into the old behaviors. A relapse is considered a full fall back into the old destructive behaviors. It may be short-term. It may be as short as one or two days. Usually though, it implies a week or two, or months or years. A lapse or a slip is considered a single episode, one day, and not that severely re-initiating, not only the destructive behavior, but all the consequences and all the other associated behaviors that go with it.

Why does relapse happen to behavioral addicts?

Relapse happens to behavioural addicts because it's very normal to relapse. No matter what it is that you've done for a long period of time, it is still difficult if you are asking yourself or someone is asking you to not do that. Let's say we asked you not to brush your teeth; I think if we asked you not to do that, if you'd keep it in the forefront of your mind for a day or two but you might just relapse, pull out that toothbrush and put on the toothpaste and brush your teeth. It's normal to relapse; it's not bad to relapse. It's funny the way relapse is discussed in the disease model as something evil or bad. If someone came in for cancer and the doctor got it into remission and it came back again, would we call that a relapse? Well, maybe, but there wouldn't be the shame associated or as presently sort of conveyed to the client that they're 'bad' because of relapse. Relapse is normal. If you were depressed for example, would you ever expect depression to come back? Of course you would; life is not a static state, you have to recognise that you've practiced this behaviour, destructive as it maybe, many many many many times, and to never fall back and to never default to it is somewhat impossible. The key, of course, is not to shame yourself, not to blame yourself, and to try to learn from what happened that led to this fall back.

What are the predictable triggers that lead to relapse in behavioral addiction?

There are some very traditionally situations that are predictable triggers for relapse. They generally are thought of as both internal and external. Internal ones would be uncomfortable feelings, such as return of depression, return of anxiety, return of certain stressors, a re-remembering of certain traumas in one's life. These are all internal states that bring about, often trigger, a relapse. And then there are external ones, such as the friends and family and liquor stores and people that you associated with that often could trigger a relapse.

What are high-risk situations a behavioral addict should avoid?

There are many high-risk situations when you are recovering. But, this is an extraordinarily important point: in the disease model, in the twelve-step model, there is a belief that all high-risk situations should be avoided. Let's say there was, you were trying to recover from alcohol or something like that, and there was a big party this weekend. You would probably be advised not to attend, because that's a high-risk situation, or after work, at a bar. But in the harm-reduction, or the cognitive-behavioral approach, or the approach I sort of advocate, the belief is that those high-risk situations have to be actually reintegrated into your life. The ideal goal is maybe not the first week, or the first month, maybe, to involve yourself in these high-risk situations, but ultimately, you must be able to go into a bar or a situation that was a historical trigger, and find yourself not engaging in the destructive behavior. If you don't go into the high-risk situation and come out the other side without engaging, you are at great danger that at some time back in or at some point in the future, you're going to find yourself in the situation, and have no way of coping with it. If you, on the other hand, go into the situation now, and with the intent of not engaging in the destructive behavior, you are neutralizing the intensity and the fear that will be brought up. You are acquiring new skills of communication, of socialization, or whatever the event might involve.

Can medication help to keep a behavioral addict sober?

It's my opinion that medication can be extremely helpful in recovery and of course this depends on the addiction that you have and whether we have the medicines that will address your particular addictions. But, medications aren't going to cure the addiction, but they are going to diminish, perhaps, the craving or urning for the involvement in the destructive behavior. There is going to be a punishment such as that, if you do involve yourself in that destructive behavior, you are going to have a bad experience, such as through the use of antibuse or something like that. So, therefore, I do support the appropriate use or the scientific use of current medications to help one obtain and sustain new behaviors

What can a behavioral addict learn from relapse?

Relapse can be an extraordinarily positive experience if you sit down after a relapse, in a sort of calm state, with a piece of paper and ask yourself such things as what was going on just prior to the relapse, who you were with just prior to the relapse, how you were feeling inside just before the relapse, what you were thinking just before the relapse, if there was a life event that has occurred that could account for this relapse, what the forces were, if you were hungry, if you were tired, or if you were feeling something uncomfortable that led to the relapse. It is an opportunity to take that sponge that's full of information inside your brain, squeeze it dry, and look at the insights that you can gain. Generally speaking, these insights are only available to you right after the relapse happens, so in general, the sooner the better.

What kind of plan can prevent relapse in behavioral addiction?

Ideally, you take this information after the relapse, and you strategize to try to see whether there are patterns? Are there people that you should be avoiding? Are there any particular type of events you should try to avoid? And, if you can't avoid those events, how would you handle - and I'm just going to use an example - that party next time? What would you want to equip yourself with? Would you want to have someone within the party to help you stay on track? There's lots that can be derived from this process of relapse debriefing, and using it to plan the next round, because life will present another round to you, and you want to be better equipped. But it's so difficult to specify what you can do with it, because there are so many scenarios that go along with that relapse.

How can I tell if I need extra help with behavioral addiction recovery?

The need for extra help is a very personal decision. I, of course, as a mental health professional think that extra help is always useful. If you were on a diet, would you not hire a private trainer if you could, or if you were in some other situation, getting a degree in something, would you not take a class. Extra help is a normal part of it. There are a lot of people who feel ashamed to reach out and ask for help with their behavioral addiction. I'd like to encourage you people to say, why reinvent the wheel? Why not buy a self help book at minimum? Why not utilize other people's journeys and maybe even glean something for yourself out of it, rather than you having to learn every single step of the way anew when recovering from behavioral addiction?