7 Risk Factors for Relapse
By Bill Abbott, MD
Over the course of time I’ve observed several sets of circumstances that seem to increase the risk of a person with an addictive problem to sustain a relapse – that is, falling back to the former behavior. I must honestly state that this is an observational piece and I am not sure that there is any science behind it. Nevertheless it certainly does make sense that some of these circumstances do heighten the risk for a temporary or even permanent stepping out of the stages-of-change process which we call addiction recovery.
The 7 Risk Factors Are:
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Fantasy
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Rumination
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Boredom
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Persisting Frustration
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Intense Emotion
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Social Disconnection
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Opportunity
What follows is a short description of each of these.
Fantasy Thinking about a possible future scenario in which your behavior of choice has become usual or frequent. Falling into this category would be “romancing” the use of a particular substance or behavior. By this, I mean forgetting the negatives and remembering the positives of the “using or doing” experience.
Rumination Rumination is the opposite of fantasy in some ways. This is thinking about the past in a circular fashion. Reinforcing negative thoughts and continuing feelings of guilt or shame about one’s previous behavior would fall into this category.
Boredom Boredom is self-explanatory. When one is bored one is also prone to ruminate or fantasize.
Persistent frustration By this I mean a situation which is ongoing and for which there seems to be little opportunity or choice to make a change. For example, being “trapped” in a job that you do not like or responsible to a supervisor who is consistently and persistently difficult.
Intense emotion Any emotion that is extremely intense and tends to persist awhile would fall into this category. For example, grief over a loved one’s death or the loss of employment or a divorce.
Social disconnection This is a slightly harder one to understand. By this I mean being cut off or isolated from our usual activity or community. Man is a social animal and even though he does not need be with people all the time, to be separated can be painful and cause suffering. This might occur because of self-imposed isolation, or conversely it might be caused by rejection or ostracism.
Opportunity This may be the biggest one of all and certainly adds to any of the previous ones should it arise. By this I mean having the time or space where one feels one can safely resume the previous behavior without being noticed or “caught”.
Suffice it to say that more than one of these can present itself at any point during the recovery process.
Being aware of these factors, I think, is the most important point I’m trying to make. Knowing in advance or knowing that it is occurring as a risk to relapse can arm oneself to taking measures to counteract it and not fall into the trap leading to lapse or relapse.
Bill Abbott is a long time SMART volunteers who, in addition to numerous other SMART volunteer activities, facilitates weekly SMART meetings in the Boston area.
