Written by Deepak Bohra
I have observed many patients coming to the rehabilitation, take the treatment and do not consume any substance post discharge and continue it only for a limited time period with no efforts to control, which makes them feel confident due to which they stop taking the therapy sessions midway and also the medical compliance decreases with time. After spending few days to few months depending upon the seriousness of the treatment taken by them, the patients meet their first slip out of nowhere. How did t their happen? When did it happen? I was doing so well and I don’t know what caused it?
These are few questions which the patients have in their mind when they come for re-admissions after a full blown relapse. What was stopping us until our first slip?
We may call them “LIFELINES”.
It may sound very abstract and philosophical but it has proved very useful while dealing with my patients in real practice once they get to know how does this theoretical perspective works.
Lifelines
We must have played Nintendo (video games) eg: Mario, when we were young. These games were very cleverly made to engage us for a long period of time and not easily lose interest in them. One of the techniques they used to make them interesting was by earning Lifelines.
Lifelines were like the shields the player has around himself which protect them from the probable dangers and hurdles by being used and ultimately saving the player and keep the game going without losing the progress. These lifelines are earned by completing some tasks assigned within the game for the player which help them finish the game.
Lifelines of Relapse:
Very similar to the characters in nintendos and video games which are already inspired and developed imitating the human life, people who suffer through disorders of addiction when come for a treatment in a rehabilitation and take the complete treatment, develop layers of invisible shields around them which protects them from slipping to hurdles and challenges of slips post discharge. These lifeline shields are strong but limited in numbers which make the patient feel invincible whenever they face any situation which can be a trigger to substance usage (eg: going to friend’s birthday party where alcohol is openly served). These lifelines mimic the characteristic of a non drinker who does not have to control the drinking urge as it’s not actually present there. They help the patient in taking the time for full recovery and bring a permanent change by the means of medications, therapy and changing the way of lifestyle.
These lifelines have a metaphorical existence but they work as a safety net for a limited time period until renewed as these were very hardly earned and are precious.
Let us understand through an example:
Suppose patients complete their recovery program in a rehabilitation center and upon discharge they are advised to abstain from social gatherings where alcohol might be served which they fail to follow after sometime and attend a party with their friends. They socialize openly with everyone like old times but something special happens this time. They did not get the urge to drink without even working hard to control the cravings and came back home sober. They believed that they successfully were able to accomplish their addiction using their will power giving them a feeling of confidence. What’s different this time!
They were unconsciously protected by the lifelines which prevented them from feeling any kind of urges for substance use. However, the individuals often mistake the effects of these lifelines for their own permanent self-control. This false sense of security can lead them to believe they are “cured” or fully recovered, not realizing that their resilience is temporary and dependent on the lifeline.
How to use these lifelines:
The most common question asked by patients in a rehabilitation center is: If I will quit substance forever then will I never be able to socialize, as doctor has prescribed me to abstain from any social gatherings ?
These questions arise when patients suffering from substance addiction consider themselves normal and starts comparing themselves to others around them. It is therapists role to make the patients bring an insight about their illness and it’s severity and chronicity.
As soon as patients will enter any such gatherings or exposures to the substance, they may come out sober without realizing that one of their lifelines has been used.
So as mentioned above, these lifelines are temporary, hard earned and are precious which have to be used with caution. So there is a supreme need that the patients who have recovered from addiction, should prioritize occasions and events of their life.
For eg. The patients who have been very extrovert and social and never missed a party throughout their life may think of attending the same number of parties post recovery which has to be taken care of. The patients have to prioritize the occasions on the basis of these lifelines. If the patients have earned 7 lifelines, they can attend the best and most prior 7 events of their life without risking their slips and relapses which is way better than not attending any or attending all.
But if the patients keep attending the parties with the false confidence that thus is their will power and not the lifelines protecting them from slips, they will become easily vulnerable to the first use of the drink sooner which may lead to a relapse.
In the initial stage of recovery, the patients may spend a good time being sober and not using substance despite being exposed to triggering and substance luring circumstances and misinterpret their sustained sobriety as a sign of a permanent recovery.
Once all these lifelines are used, the patients return to the same stage of vulnerability for the initiation of first use of substance and this time it does not follow the cycle of hobby-habit-need-helplessness-disorder. It directly moves to need-helplessness-disorder within few days of the first consumption of the substance.
Heightened temptation: Once the brain is back to its pre-recovery state, the capability to fight the temptations deteriorates. The patients may now succumb to temptations in the environments that they used to have guarded, hence increasing the chances of reverting to undesirable behaviours.
Defeated Relapse Prevention Strategies: No rescue efforts have a systematic effect. The patients expose themselves to active addiction which was present pre-recovery unhindered by any care. Even a single episode of using a substance is capable of reviving the process of addiction working like a domino effect.
How relapse is a reset:
When the patients relapse, they tend to feel as though they’ve gone back to the starting point of their addiction problems. Relapses, just like an initial addiction, are almost always progressive in terms of its development. Initially, there seems to be a stage of no risk or danger of control but the body and the brain are soon getting back to dependence. However, the momentary hope which is sometimes called illusory control—where they believe that they can take drugs without being dependent on them—disappears and the patient is often in a deeper den than before.
Conclusion
In the end, the lifelines cannot be considered as a permanent way out but only as a temporary means to assist addicted individuals in their recovery. Their aim is to serve a stopgap measure, but it is necessary to say that the real recovery ‘work’ is to establish such rescue lines as relatively short-lived lifelines, over the top of which people need to construct a more pervasive than these ‘lifelines’ measures and approaches to these real issues.
To sum up, the mechanics of the Lifeline Theory make it clear how fragile the time frame of sobriety is in the beginning and how important it is to progress and keep aware always. Lifelines can be of great help at the very beginning of the process of addiction recovery, but in order to achieve a worthwhile long-term outcome, it is clear that these protective devices embrace only part of the solution. It requires continuous work, assistance, and awareness of the dangers of the addiction situation.
