Podcast: The Fear of Relapse

Relapse is a major fear for those in the addiction and mental health field. It can be difficult to define what relapse is, and there are often unrealistic expectations around it. This can lead to an unspoken sense of risk for those working in this field. Clare Waismann, M-RAS / SUDCC II, a registered addiction specialist and David Livingston, LMFT specializing in addiction therapy, discuss the fear of relapse, the complexities around defining it, and the ways to manage it. They also offer realistic expectations around relapse and provide advice on how to deal with the risks involved. This podcast is an essential listen for anyone who are struggling or recovering from addiction.

Dwight Hurst, LPC: Welcome back to Addiction Recovery and Mental Health, a podcast by Waismann Method Opioid Treatment Specialists. I’m your host, Dwight Hurst, and I’m joined, as always, by Clare Waismann and David Livingston. How you guys doing?

David Livingston, LMFT: Hi. Good.

Clare Waismann, M-RAS/SUDCC II: All right.

Dwight Hurst, LPC: Well, I got to pick the topic today, and I’ve been thinking a little bit about this lately, about the fear that people sometimes have when they get into sobriety and they get into health management. They’ve been clean from drugs. They maybe have gone through detox, they’ve gone through whatever process would they got to get to a stage where they’re kind of just they’re managing and maintaining where they’re at with sobriety. And then there come these fears, these fears of what if I mess up? What if I fall off the wagon to use a really old expression? But you know what? If I what if I have a slip-up or a mistake or anything like that? And that could become just so powerful in people’s lives. And I want to see what just our mutual experiences and feelings have been about that.

Clare Waismann, M-RAS/SUDCC II: I don’t know if the word powerful or debilitating when we describe that kind of fear. I think in most cases it is debilitating. It stops you, you know, from advancing or on your sobriety or in seeking sobriety.

Dwight Hurst, LPC: That’s a good point. Knowing people might even hesitate to engage with treatment because of that fear before they’ve even gotten stabilized.

Clare Waismann, M-RAS/SUDCC II: I think fear something that we usually don’t understand the root of. And by understanding the root of our fear, we can usually help manage it and it becomes a bit more, you know, attainable the solution. So right, David?

David Livingston, LMFT: All feelings are good. How we understand them and whether they’re in alignment with our values is really the question. So fear of getting into treatment when you’re in trouble because fears and inhibitory emotions. So it inhibits us. So if it’s inhibiting someone from getting into treatment, then often the fear is preventing them from getting better. Usually almost always being in alignment with what they really want. You know, sometimes there’s fear of the process of getting off, of just going through the detox process, which is why, you know, our process is, I think, speeds it up and helps people with that as much as anything. But fear in that regard can really prevent people from getting better. And also, you know, and fear of being ashamed or telling people or taking time off of what will happen. I mean, there’s all those fears that I hear all the time. And then conversely, when you are off it, like, you know, you use a phrase falling off the wagon, listen, if the wagon’s going 60 miles an hour, nobody falls off it. Right. So fear. Fear is fear. Fear is good once you are sober. Right. Because the fear is like, oh, it’s because it’s really hard on people to go back to a state of being dependent again, having unhealthy dependency and stuck again, and then all the ramifications that can come with that. And fearing that and having it inhibit that process is really good. So, you know, it just depends on on sort of how that’s working and and, you know, and then so you want the fear and alignment with your values is really kind of how it works.

Dwight Hurst, LPC: It’s like there’s a balance there of like, how much is too much, right? You cross the line or it becomes crippling rather than becoming inspiring.

David Livingston, LMFT: Yeah, no question.

Clare Waismann, M-RAS/SUDCC II: I think also the fear becomes from, you know, can stand from past experience as well, where, again, you know, we did not understand the reasons of and I hate to using the word failure, but that’s what most people would, you know, identify a relapse as by not understanding they feel, you know, powerless over the possibility of that happening again and again, letting everybody down, including themselves. I think it’s really important to understand, you know, where it in the past came from and what trigger and work in finding tools to deal of those, you know, unwanted feelings that are usually the trigger for relapse.

Dwight Hurst, LPC: It’s interesting when you mentioned that this idea of failure where from a very like technical definition, it’s like failure in this area, a failure of a goal. You know, I did a thing that I really you know, I don’t do that anymore, but I did it. But yeah, there’s an emotional definition that I think stokes the fires of that that fear. Right? The emotional definition or the emotional attachment we put to failing at something to where all of a sudden I’m internalizing this and I’m a failure instead of I failed at a goal today that I sometimes, you know, I’m usually successful with. But today I wasn’t. That’s a whole different ballgame than saying to myself, Oh, I’m a failure. That’s who I am for sure.

David Livingston, LMFT: I mean, now you’re getting into like, the idea of shame, right? Shame versus maybe guilt like this. I’m not living up to the way I really want to live. And, you know, and so that type of guilt can move people to say like, okay, I want to do better. I want a different life. This isn’t me and how I want to live. Right. And again, it comes back to the kind of being in alignment with your values and that’s helpful. But when it becomes sort of embedded as a feeling of man, there’s I’m wrong and I’m not good. And that can just confuse you. It doesn’t necessarily help separate and identify what it is you really want and then move you into an alignment with it, which is what you know, which is why the best reason to get sober and the best reason. So because, you know, it just complicates and negates it, you know, a healthier vision for a life.

Clare Waismann, M-RAS/SUDCC II: There is also, I believe, a great factor of expectations, you know, and again, realistic expectations that can lead, you know, to those feelings of not just of wanting to relapse, but of, you know, failing what I expected for myself. Well, I think sometimes not just the patient themselves, but everybody around them. The expectations are so beyond what can be delivered. You know, there is you’ve got treatment now that that doesn’t mean that your life is going to be great and your relationships are going to be great and everything is going to be positive and happy all the time. Far from that. No, You’re dealing with life on life’s terms and there is going to be letdowns and there is going to be steps backwards. But it doesn’t mean that the whole path you went forward was in vain.

Dwight Hurst, LPC: Yeah, that’s an excellent point. I know that that’s something that I’ve heard a lot of people refer to is the idea that, you know, if you’re trying to be sober and you’re trying to stay away from, you know, opiate abuse, for example, then that goal all by itself is not… yes, we want to be healthy. But I think it’s important to remember like being healthy in all things, you know, each thing is its own goal or to be as healthy as possible. That’s a goal. And then there’s the goal of avoiding substance use or substance abuse. Right? And if I’m doing so, if I’m as a colleague of mine used to say, if I’m walking into a decision and I’m making the wrong one, but I’m doing it without abusing drugs, I have some success there. If I go over here and make a really bad decision, I’m doing it sober. I’m doing something right, and now I can work on that choice and maybe make a better choice if that’s if that it makes sense.

Clare Waismann, M-RAS/SUDCC II:  I don’t know if I agree with that 100%, Dwight…

Dwight Hurst, LPC: Oh, no, obviously.

Clare Waismann, M-RAS/SUDCC II: Yeah. Yeah. Although I think when we are under the influence of any substance, it makes it hard for us to make, you know, good decisions because, you know, our thoughts are compromised. But with that said, we can make pretty, pretty bad decisions and harmful decisions when we are sober as well. So I would think more of the intent to be healthy, physically and emotionally healthy and do whatever we believe is going to give us the best quality of life altogether instead of concentrating on being sober or not using any substances. I mean, because I think in reality sometimes somebody that had had treatment for opioid dependance might need to use, you know, an opioid to control management, pain management for a short amount of time. And that doesn’t mean they fail. And we get this call all the time. I was in a hospital and they had to give me morphine for two or three days. You know, should I come back for treatment? But are you still taking opioids? No, no, no. It’s just for two or three days. But you understand, I’m saying, because the whole sense is if you use that substance, it makes the substance so much bigger than your own will to be healthy.

Dwight Hurst, LPC: And that is an important point, I think is not to let because you can let just like you can let alcohol or drugs be too big in your life. I know we talk about this sometimes, how sometimes there’s a danger of letting treatment or recovery become overwhelming in your life.

Clare Waismann, M-RAS/SUDCC II: I have met a lot of people in my life where recovery became their life, and that is all they do and is from meetings to being people for meetings, or they feel almost as not belonging, you know, to a world that is not part of recovery. And I don’t know, again, how positive that is as well.

Dwight Hurst, LPC: Yeah.

Clare Waismann, M-RAS/SUDCC II: That’s what I’m saying, David.

David Livingston, LMFT: I do, I do. It’s, you know. Yeah, it’s. Yeah. Ideally, ideally you want your world to be expanding and growing. And in fact, I think that when you look at the long-term treatment. For any for addiction. But really anything is what you see is there’s a balanced life that’s good enough and and and that is individual and we all want different things. And you know what the balance is for each of us personally is different. But for that person, they, you know, and so they moved it around that they’ve created a balanced life that includes, you know, healthy dependency. You know, one of the things we don’t talk about much at all is what a healthy dependency is. And, you know, and so I think that’s kind of at the root of what you’re bringing up. And it’s one of the core aspects of having a good life and one of the most important aspects that are not really dealt with in terms of getting sober is that you have to create healthy dependencies, you know, which which we all need, right? That’s why it’s what society is based on and what families are based on. And, you know, work situations that are good or based on like all these things where there’s a give and take and we give something, we get something. And, you know, and the problem with addiction is that you get you you you don’t get anything that leads to your growth and development and expanding life. It just shrinks your life over and over. So. Right so yeah.

Clare Waismann, M-RAS/SUDCC II: I think the balance, Dwight that David just referred to it’s huge. It doesn’t matter what we’re talking about. You know I think in life having balances it’s you know primary to in any healthy situation.

Dwight Hurst, LPC: Yeah and I guess that’s a good clarification when you know when I go into that and say do we get overwhelmed with recovery in treatment. The funny thing is somebody can be doing more treatment than someone else and not be doing that, whereas someone else can be overwhelmed by that.

David Livingston, LMFT: And what your life looks like. For some people, there are people who maybe, maybe they’re too alone in their life and the meetings and everything really fills that void, you know, significantly and really creates a better balance. And then there can be other people where, you know, it can it can really be overestimated how much they need that. And really treatment is looking at aspects of a person’s life and then talking to them and helping them think about it. So they so, you know, because we all overestimate and underestimate things at times. Everybody it’s probably the most human thing I know. And helping someone sort of think that through so that they sort of scale things to the right size is it sounds simple, it’s not simple and it’s more profound than people think.

Dwight Hurst, LPC: So I’ve known people that have gotten very into different communities, sometimes into more cognitive behavioral therapy (CBT) or rational mode of treatments or other mental health treatments and sometimes into 12-step groups. And it’s interesting because I’ve seen some people who get everything in their life become all about drugs. And that’s what they talk about. That’s what they think about that. So then I have a friend who’s very heavily immersed into the 12-step community. And at the same time, from what he has told me, he said, I rarely think about alcohol and drugs. I think about just what we’re saying. I think about being healthy and, you know, how can I be better in my marriage? How can I be better to my kids and how can I, you know, all those things. And it’s interesting. It’s the same well to go and drink from, but it depends if we are allowing ourselves to explore kind of what is our individualized health need and that type of thing.

David Livingston, LMFT: If you’re hungry and you haven’t eaten for a while, the pain of the hungry hunger makes you more self-conscious. And that’s what it’s meant to do because the pain gets your attention and then you become conscious of the fact that you have got a need. So what happens is, is as needs get met appropriately and in a good way as you get the meal you need, you move on, right? You don’t stay there and you keep eating, you move on you. And so your life expands. So as you get your needs met and you know, in a good way. Right. Just like you’re saying, do I? Then you start thinking about, oh, you know, how’s my marriage? What do I want to do with my kids? You know, I could I got some stuff I need to get done at work or whatever it is. And, you know, let’s get an exercise routine. All the things that, you know, are some of the staples of people’s lives generally. And just and on and on, you know, and. So so and by the way, those needs persist forever. So the reason I mean, and I’ve spoken of this before, but I never hear it put this way, and I feel this strongly. The reason they say addiction, you know, you’re an addict and it goes on forever is because needs to go on forever. It’s not that we’ve had a good meal and we’re going to never be hungry again. No, we have a need to eat and drink and we have a need to have fun with friends we have a need to have. Right. So as these things get dealt with and a life, a balanced life that’s appropriate for the person, and again, they get to decide what that balance is, is that starts to come into focus and that starts happening. The tensions driven by unmet needs go down. And that’s a lot of what drives addiction.

Dwight Hurst, LPC: There’s a mentality that exists. I wanted to ask you guys about this. If you’ve heard this or seen this, and I find it to be quite a dangerous mentality that people get into. I’ve heard people say before, boy, if I ever relapsed, if I ever went back to using, that would be it for me. I think I would just die. I think I would never get clean again. I think I would there’s this fear of like if I cross that line again, I’ll never be able to escape it, so therefore I better not. And I think some people think that that’s a motivational statement. And I can’t say that it isn’t for everyone because I don’t know everyone, but I find that I find that a little bit dangerous because, well, what happens if I do? Then actually do I follow through and my life is over? Because that has that doesn’t go anywhere well, or do or is it going to be, “Well, I just, you know, live in fear of that forever because that’s the end of my life if I do it.” Do you guys run into that? Have you seen or heard people say.

David Livingston, LMFT: I’ve heard it.

Clare Waismann, M-RAS/SUDCC II: Hundreds of times.

Dwight Hurst, LPC: Yeah, that’s what I thought.

David Livingston, LMFT: I figured I could tell you how I respond to it, because I, I, I’ve heard it hundreds and hundreds of times and I say pretty much this every time. Don’t ever tell yourself that. It’s just some chemicals. Your life, comparing your life to these chemicals is the wrong comparison. I’m not saying you should ever relapse because it’s terribly hard on you. It’s hard on everything. And you and if it feels like it helps you to feel like it’s that dangerous, great. But don’t if that were to ever happen, you cannot ever tell yourself that your life’s over and stuff. You get off it again and you get it off it as quickly as you can. And look, don’t do it because it’ll just be terribly hard on you. And that’s my response to it. It’s basically the truth. And, you know, so I think it’s dangerous to create such, you know, I mean, one of the things that does help people is the idea is the adage “one day at a time”, because it limits this feeling of these living up to some extreme ideal that you may not feel up to.

Clare Waismann, M-RAS/SUDCC II: I think I think any absolute, you know, any extremes in life is not good, regardless if that is for maintaining sobriety or relapsing. So, you know, it’s again, understanding the reasons why you happen and moving forward. And sobriety is, you know, an important part of life for so many is not everything is just, you know, one factor and thousands of factors that makes you who you are.

David Livingston, LMFT: Yeah, that’s. my thought is I find that a certain amount of psychological flexibility is safer in a way to say, well, I’ll deal with what comes because I’m healthier now. And if something does happen, you know, for most people I find in counseling, one of the best things to do is as quickly as I can to transition to the thought, what can I learn from this? Because a relapse is once it’s happened, it’s an opportunity to learn where the holes in my armor are.

Clare Waismann, M-RAS/SUDCC II: Yeah, right. I don’t think the relapse experience is always the same. I think, you know, as we get older, as we learn more, I mean, for some it could be much worse. For some, you know, it could be much shorter and easier and faster in becoming sober again. So I think expecting the worst. It’s not always productive on sobriety.

David Livingston, LMFT: Right And that. That’s right. So and in treatment, you have to help people differentiate. So if someone has cravings, the first thing you do is you find out why. Like, okay, “How’d you sleep last night?” “Well, I only slept an hour and a half.” Okay. “You know what else is going on?” “Well, I’ve got you know, because I’m not sleeping. I’m more anxious than I normally am. And I find myself having cravings and cravings.” “So, you know, what do you feel like you need to help you feel better and so forth?” “Well, that’s why I’m having cravings for opioids”. And so I’ll say, look, you’re you’re not actually having cravings for opioids. You’re having cravings to feel better. And what’s going to help you feel better is if you rest and if you and if you rest and your anxiety goes down some, then you won’t crave the opioids. And they’re like, yeah, actually that’s right. That’s that’s true. So and but you can’t think of anything right now that’s going to help you with those two things. You’ve ever got help for it? A little bit. Not really. So it’s again, it’s those needs. And then what happens is the mind just remembers what it helped it. And so in treatment, you have to persist until you find other remedies that don’t get you in trouble, that aren’t going to create issues or like with anything. And then there’s options. So if you know, a lot of people have insomnia or have sleep problems, a lot of people. And so is that get sorted out, you know, you know, the craving gets sorted out and then also the differentiation, the opioid falls away. It gets be smaller and smaller because there’s, you know, there’s other things. Yeah.

Clare Waismann, M-RAS/SUDCC II: It’s sound, you know, I’m sure you’ll hear about the word “pause”. I relapsed because I couldn’t handle “Pause”. So what is “pause”? If you ask 50 people to describe “pause”, they’re going to describe 50 different things that they felt. So. So it’s what David is talking about is, you know, it’s not that you relapse because you crave the drug. You relapse because you are having some issues with if it was sleep or if you had anxiety or depression that opioids were masking or alcohol or whatever substance once you became sober surfaced. So it’s an issue. It’s an issue that was not dealt with that surfaced. And sometimes a combination of different issues that one is leading to the other. As David was saying, like lack of sleep is tremendous. You have lack of sleep, you have no energy, you become depressed, you become anxious. It just snowballs into another symptom and another symptom that leads you to want to self-medicate, period. Is understanding, understanding the person, understanding what they’re going through, trying to pinpoint the root of the issue and not making the substance the issue, but realizing there is an issue that the substance is actually medicating.

Dwight Hurst, LPC: Yeah. And when you are doing something to address an underlying concern, you’re trying to solve it. You’re trying to and often the underlying concern is actually a healthy one. It’s healthy to get enough sleep. It’s just not not every method of trying to do it is healthy.

Clare Waismann, M-RAS/SUDCC II: Correct.

Dwight Hurst, LPC: I don’t know if I’ve ever mentioned halt on the program before, but that’s an old saying. Halt! Which stands for “Hungry, Angry, lonely, tired”. Right. It certainly isn’t all of the possible underlying things, but it’s like if you’re queued up and having cravings and triggers to relapse, then you’re supposed to say to yourself, Well, hold on, halt. Am I hungry, angry, lonely or tired? Then maybe jump off to other needs as well. But that’s just a good check in someone can do for themselves. And the interesting thing is, even without it being tied to substances or addictions, I found for myself, if I’m emotionally destabilized or, you know, flooded with emotions, it’s actually pretty good to stop and say, how are my physiological needs going right now? Am I being healthy for myself? You know, and self-care is so much more than, you know, just going to a party or doing something fun or taking a bubble bath, Right? It’s also getting some exercise and getting enough sleep and eating things that won’t make me feel sick in an hour or two.

David Livingston, LMFT: All right. That’s a great acronym. It just moves you right back to your needs. And if you identify the needs and you go and kind of do something to help them, it’s not just a treatment, but that’s the core to building a good life. And treatment is building a good life, a life that you like and want to protect.

Clare Waismann, M-RAS/SUDCC II: I had a conversation with somebody two days ago and he was saying to me, But, you know, you need to understand what I am telling you. And I said, Yes, I can. I’m hearing you. You need to hear your body as well. And you need to hear what your body is telling you. Think about what is that we need? What is that we are missing? What is that we are ignoring?

Dwight Hurst, LPC: But that’s one of the reasons I think we come back to mental health and emotional health so much on this program when we talk about it. Right, is that there is a heavy dose of trying to meet a need. And if we don’t understand that, not only do we fail to meet the need, but we the shame kicks up again. If I attribute my substance abuse to I’m a bad person, then I don’t get better if I attribute it to oh, actually, I’m trying to work through some trauma and I didn’t really realize that for a long time. Well, that’s just a need then. That’s just a thing that happened, right?

David Livingston, LMFT: Right? That’s right. But there has to be confidence that the need can be met in a different way. And so as people feel confident, I mean, truly feel confident that they they can get sleep when they need it. They’ve got other ways. They’ve got a doctor that will work with them and find healthy ways for them to sleep. They get in a good exercise routine. They get up in the morning and move into sunlight, which helps reset the circadian rhythm. They learn and start to feel confident that they can manage something. Then there’s that that hopefulness really creates a momentum and other directions. And I think what happens in a lot of treatments is that the underlying needs and the concerns aren’t really addressed and there isn’t a strong sense of hope. And so what can creep into a person’s mind is and this is one of the dangers of particularly opioids and substances, is it will shift how you feel initially. Now it’s you know, it’s a dead-end street. It doesn’t go anywhere. And then and all the above. And worse and worse, especially with fentanyl, can be lethal and is all the time now. So it’s but but nonetheless, there has to be confidence that the needs can get met. Right. I mean, imagine if you’re in a desert and you there’s nowhere to drink and, you know, you feel like the only thing you have is an opioid to take. Well, that’s how a lot of people feel. They don’t really and or not it’s not always that extreme, but it literally doesn’t really come to their mind that there’s a lot of other good options. And so the more confidence they have in that, to the less the less chance of relapse, less chance of, you know, going in directions that just make life harder on.

Dwight Hurst, LPC: Thank you so much for listening. That’s going to do it for today. Addiction, Recovery and Mental Health is a podcast that is created by Waismann Method opioid treatment specialists and produced by Popped Collar Productions. If you would like us to answer your question about addiction, mental health care and recovery, or any related things, please email us at info@opiates.com, and we can address that on our next episode. We’re always excited to hear from listeners and to see what people are going through. You can also follow us on Twitter @opiates. Our music is the song Medical by Clean Mind Sounds. As always, we encourage you to keep asking questions because if you can ask questions, you can find answers. And if you can find answers, you can find hope. We’ll be back with you again soon. Bye-bye.