Post-Relapse Treatment

I arrived at rehab a member of the “Four-0 Club,” the designation for anyone whose blood-alcohol was above .40, five times the drunk-driving standard. The second time I was admitted my blood-alcohol was a “mere” .28, only three-plus times the limit. The intake nurse joked that was a sure sign of progress and noted in my chart, “better shape compared to last admission,” but I didn’t see anything funny about it.

When asked what precipitated the relapse, the hospital chart say I replied, “I don’t know. I was having too good a time,” but I have no memory of it. My doctor wrote: “The plan with Steve will be to detox him rather quickly and then get him re-acclimated into the 12-step program. I believe that this is what we call a green relapse in that he was only drinking for a few days. His assets are that he presented himself very quickly, that he has a strong sober support group. His liabilities are that he is new to being an alcoholic and it is a little tough on him.”

That evening I attended a hospital AA meeting and shamefully recounted the circumstances of my relapse. Afterward, a woman I knew from the Alumni Group came up to me. She was in her 70’s, with some ungodly amount of sobriety.

“I know you feel like shit right now,” she said, startling me, as I never knew her to use such language, “and that’s entirely appropriate, ‘cause you screwed up.”

Gee, thanks, I thought, you really know how to make a guy feel better.

Then she continued, “You know why you relapsed?”

“Not really,” I said, truly perplexed.

“I do.”

“Feel like telling me?”

“Because you’re an alcoholic, silly man! That’s what we do. That’s what’s normal for us. We drink. No matter what happened, you drank because that’s how alcoholics respond.” Then she asked, “Will you do me a favor?”

“If I can.”

“Go ahead and feel like shit now and the rest of the evening if you have to. But promise me that tomorrow you’ll make it your goal to forgive yourself, feel better, start over, and learn from your slip.”

Her response was typical. Sober addicts and the rehab staff were light-years more forgiving of my relapse than I was. They knew how normal it was and most of them had relapsed themselves. They reminded me how hard new sobriety is and how little experience I had coping with it. They urged me to forgive myself by absorbing the lessons of the relapse and not repeating the mistakes I’d made. “You’re a typical addict going through a typical relapse,” they said. “Understand that and get back into the welcoming warmth of the program.”

This was exactly the opposite of what I feared. They made the shame of relapse somehow bearable. And if you could imagine that, it was more likely that if you slipped again you’d come to your senses no matter how hard it seemed instead of sinking deeper into dejection, concluding a drunken demise is in store and you might as well get on with it. It’s the fear that others will think badly of you that exacerbates the shame, guilt, embarrassment and bewilderment that accompanies relapse and keeps many relapsers from seeking help again. It can lead to months and years of using before they attempt to get sober, requiring another bottom to get desperate enough to try again.

The bulk of my five-day second rehab stint was devoted to withdrawal and ferreting out the triggers of my relapse. For me, detoxing from .28 was a relative piece of cake. Dissecting the run-up to the relapse, however, was much harder as I was forced to relive the pain of the past days and inventory the many errors I’d made.

My post-relapse treatment was largely devoted to parsing what led to my first drink. It was easy to blame this or that or that person, this or that situation, or a combination of them, which I’m sure I did for a time. But these were mere specifics, not causes. The staff forced me to realize I was the cause. I hadn’t realized how noxious my anger was so I hadn’t even looked for a way to exorcise it. Delving into the events leading to the relapse with a whole new cast of rehab-mates, we explored its relation to unexpressed resentment — fury at myself and what I’d become, mostly transferred onto others to keep me from facing my central role.

In retrospect I could see I was enraged (though incongruously, at the time of my relapse I didn’t feel consciously angry at all). I didn’t know how to deal with the identity crisis of sobriety. I didn’t know how to respond to plummeting moods without changing them with booze. I was incensed at what I’d become, had no one to blame but myself, so I did.

The staff insisted that the lessons of my month at rehab hadn’t been lost. They remained, making it possible for me to come to my senses relatively quickly, within a week. They urged me to concentrate on the success rather than the failure.

I didn’t see the success they saw, but I did learn. I learned there were no vacations from sobriety. I learned how quickly I’d go back to the depths of my alcoholism, progressing from two glasses of wine on a Friday night to vodka around-the-clock and a liter-a-day by Tuesday. And I learned how that led right back to the incomprehensible demoralization, depression, and bafflement of my life prior to my first rehab.

I also learned that even the most sincere resolutions can wither when faced with a reinvigorated addict brain. And I’d broken promises to stay sober so often I didn’t dare test myself. At my doctor’s suggestion I agreed to take Antabuse, a drug that makes you violently ill — emergency-room ill — if you drink.

I survived my relapse and I learned from it. But whatever small amount of trust I’d managed to build with my family did not. I had to start over, but from an even less-trusting starting point than when I first went to rehab (if that was possible). Agreeing to take the Antabuse helped because it was positive action, but it took a long time to rebuild any trust. I continued to take Antabuse for more than a year.

For the next article in the Treatment series click here.

To return to the Treatment Menu click here.

Subscribe to the Addict Science Newsletter


cover of A Whole Lot of Medicine

Leave a Reply