Living with the “Double Whammy”–addiction and depression recovery, I have had to learn relapse prevention for both. Luckily for me, I decided in 1976 that I would go all in with addiction recovery. I elected at 3 months sober to go to a very modest home for alcoholic women. At the time, it was the fashion to go to country-club style treatment in North Carolina. But I know that I needed to be in that modest home. While there, we worked the first 3 steps and I found the God of my understanding. I have never had anything happen that was more important to me than staying sober.
But, I have been aware of the power of using the PAWS approach for relapse.
1. From Jeanene Swanson: ‘The Condition Many Recovering Addicts Don’t Know About”:
By definition, PAWS is a series of post-acute symptoms of recovery from dependence on benzodiazepines, barbiturates, and ethanol; opiates; and sometimes, antidepressants. Some commonly abused benzodiazepines are Valium, Xanax, and Ativan, and some opiate drugs of addiction are heroin, Vicodin, and OxyContin. Symptoms of PAWS include mood swings resembling an affective disorder, anhedonia (the inability to feel pleasure from anything beyond use of the drug), insomnia, extreme drug craving and obsession, anxiety and panic attacks, depression, suicidal ideation and suicide, and general cognitive impairment.
“The brain has tremendous capacity to heal, but it doesn’t heal quickly,” says Dr. David Sack, CEO of Promises Treatment Centers and Elements Behavioral Health. Sack says that in general, PAWS symptoms peak around four to eight weeks after quitting. As the body moves toward homeostasis, says Dr. Joseph Lee, Medical Director of the Hazelden Youth Continuum, it has to reach a “new kind of normal” in the process. Some people experience a more prolonged withdrawal, he says, “and it takes a long time to recalibrate.” In fact, instead of feeling better, many addicts in recovery feel worse.
Sack says that most addicts know about PAWS from their experience of quitting and then relapsing because they felt terrible, they just don’t have a name for it. “I felt mostly good for the first five months, then I really felt sort of down and fatalistic,” Parrish says. “I knew I would never drink again, and that was OK, but I felt like I would never heal.” She says it took about four months of feeling “sad and lost” for her to begin to feel like herself again. “In those four months I had episodes of contentment, but felt mostly just down.”
While making new friends, acquiring new coping skills, and getting used to life without drugs is indeed part of recovery, untreated symptoms of PAWS don’t have to be.
The depression relapse plan involves taking careful notice of your moods and your thoughts.
2. From John Flk-Williams: “What Can Help Prevent Depression Relapse?“:
Depression has an especially cruel season called relapse. It always happens after the worst seems to be over; hope like sunlight is restored; life without depression is in full bloom. Then suddenly it’s winter again. The more often it happened to me, the more impossible the goal of recovery seemed to become.
An especially bad relapse began a couple of months after I had gotten through cancer surgery on a sustained flow of energy and determination. I had been totally up for taking on the cancer surgery, although the diagnosis had initially terrified me. Worries about cancer had also stirred a depression so deep that I felt like giving up completely. I just decided I was going to live, and the new energy marked a powerful turnaround when it came. I’d swung back from despair and passivity to hope and action. I felt I could take on anything.
That spirit had a lot to do with a rapid physical recovery from surgery and also helped me achieve what I thought was a complete recovery from depression. I stayed on this roll for several weeks after the cancer period was over, but then things changed. I didn’t collapse into deep depression all at once. Instead, I started feeling the low-grade listlessness that’s called dysthymia.
This form of depression often filled in the periods between the major episodes, so recovery never seemed to happen. Those were the blah days, no edge, no excitement to anything. There was little motive to action, certainly nothing like “drive” to get things done. I was mostly aware of the deadening routines that filled each day. There was no surprise or shock or excitement – everything turned into an indifferent hum.
That’s what started happening after the recovery following surgery. I was slow to acknowledge the change. As usual, my wife immediately sensed it and started cautiously asking me about the shifting moods she noticed. I got irritable and denied that anything was different.
The truth is that I had a lot vested in the belief that I had gotten over depression. It became almost an article of faith that I had stopped it and could now be myself again. The problem was that I didn’t have a method for dealing with relapse. When I could no longer deny that depression had returned, I was completely demoralized.
3. And, finally, check out from What…Me Sober?: “Where’s Your Stash”:
All us addicts have our stashes. They may be alcohol, drugs, serial sex partners or emotional entanglements, the extra package of Little Debbies hidden in the closet, the credit card that we use for shopping sprees, an extra carton of smokes or bottle of vape … The list goes on and on. As addicts we aren’t very good at hanging on to those things, but we never feel really secure unless we have that “insurance policy” that helps protect our addiction.
For an addict, that’s normal, but for people in recovery it can be a warning that we aren’t as sober as we might want to believe. It might be the liquor cabinet for “when friends come over,” or that old bottle of painkillers that we hang onto “just in case” of that sudden toothache that just won’t respond to Advil. It may be an old lover that we cling to as a “friend,” and just don’t seem to be able to separate from entirely (even though there’s another new — or old — lover already on stage or in the wings). Fifteen old pairs of shoes we never wear? Check. Stacks of books in case we want to read them again? Check. That old, mouldy bag of weed on the top closet shelf that we keep “to remind us of what we used to be?’ Check. The humidor full of old, stale Cubans? Check. The nicotine addiction that we justify as “being better than….” And so on, and so forth.
Our stashes ought to tell us something, if we can manage to see through our denial. They are definite signs that we haven’t been quite able to let go, to turn it over, to really come to believe that we are addicts. And the active addictions that we manage to ignore fall in there, too: nicotine, kava, shopping, sexual acting out of various kinds, toxic relationships of all kinds, hoarding, any kind of mood-altering behavior done to make us feel better or forget our troubles instead of dealing with life on life’s terms. All stashes. We aren’t ready to let go and let…well, you know.
I put it to you that a stash means an active addiction isn’t far away; that we need to examine our behavior and attachments to the things of our past (and perhaps present) addictions. Like they say, “A drug is a drug is a drug.” And an addiction is never benign; sooner or later, someone always gets hurt.