Saturday, April 28, 2012

I Don't Know What Happened ... SUDs and Relapse

Time and again I hear women say, "I don't know what happened, I just drank."  They are honestly baffled as to what caused them to slip, and as far as they can tell, it came out of nowhere. What they don't realize is that the signs were there, they most likely just didn't know how to recognize them.  This is because the events leading up to the slip didn't seem to relate to sobriety at all.

How can this be? you might ask.  Most of us assume that there are obvious red flags to warn us that our recovery is in danger.  This is true in many cases, but certainly not all.  The more insidious path to drinking winds through a series of seemingly unrelated decisions or SUDs.  It is these seemingly innocent actions that most often lead to a slip that "comes out of nowhere."

On the surface, it may seem illogical that an action totally unrelated to drinking could end in a slip. Once the chain of decisions is broken down, however, the pattern becomes much more apparent.  It is a combination of subtle painful feelings (such as boredom or loneliness) and cognitive distortions ("I can handle going to a bar") that lies at the heart of the SUDs chain.

Here is an example of how a series of apparently unrelated choices could result in a lapse.

Susan, who had been abstinent for several weeks, drove home from work on a night her husband was out of town.  She disliked being alone on the weekends he was away.  At one intersection, she turned right instead of left, deciding she needed to stop at the grocery store. Even though there was a store closer to her house than the one she decided to go to, she told herself that what she wanted to get wouldn't be available at the closer store.
The store she was headed to was on the same block as a bar she had frequented.  There were cars in the parking lot that belonged to friends of hers, and she decided to stop in quickly to say hello before going on to the store.  She was convinced that she could handle being in a bar for five or so minutes.  Once inside, her friends asked her to stay for a bit.  She did so, having a soda.

Some time later, another friend arrived and bought drinks for the group.  Susan, not wanting to be a spoil-sport, decided that one drink would be "ok" and not really a slip in her recovery. One drink led to two, then three, and eventually to a weekend of drinking.

Susan's first decision, to go to a store further from home, was triggered by a "need" for something.  Thoughts such as "I need to" or "I have to" do things which increase our exposure to alcohol can be a signal that we are actually craving a drink. Each following decision, though seemingly innocent, increased the likelihood of drinking.

The way to deal with Seemingly Unrelated Decisions is to apply the steps of recognizing, avoiding, and copingRecognizing SUDs and the thoughts that go with them, give us the chance to head off further temptation.  Avoiding risky decisions (such as stopping at a bar to say hello), and coping with high-risk situations (such as the offer of a drink) are further ways of interrupting the SUDs chain.

It takes practice, but becoming aware of potentially hazardous decisions will increase your ability to avoid high-risk situations, and protect your recovery.


When making any decision, whether large or small, do the following:

  •     Consider all the options you have.
  •     Think about all the consequences, both positive and negative, for each of the options.
  •     Select one of the options. Pick a safe decision that minimizes your risk of relapse.
  •     Watch for "red flag" thinking - thoughts like "I have to . . .", or "I can handle . . ." or "It really doesn't matter if . . ."

Practice monitoring decisions that you face in the course of a day, both large and small, and consider safe and risky alternatives for each.
Decision Safe alternative Risky alternative

Adapted from Monti et al. 1989.

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