Relapse: Chosing Short-Term Pleasure Over Quality of Life

A glass of beer and a half-empty pitcher sit next to each other on a bar.In therapy, I worked with a man, we’ll call Steven, who recently “went out,” as the twelve-step program so poetically describes relapsing. He walked away from fifteen years of sobriety, his career, his wife, and his teenage son to go on a six months binge that left him in the hospital recovering from a hypertensive episode his doctor told him was “not conducive to survival.” Before going on the binge, Steven described being called to task by his boss. He phoned his wife on the way home and received more criticism than sympathy. The Bluetooth connection dropped just as Steven passed a bar. He thought to himself, “Screw it, I’ll have one drink.” The rest, as they say, is history.

An individual in recovery, faced with the temptation to use again, has to consider two attractive, but contradictory alternatives; one having to do with something he wants in the present—a drink, in Steven’s case—the other having to do with something he wants in the future—a good, solid life, generally speaking. All humans tend to discount future over immediate rewards, choosing, say, five dollars today over ten dollars next month. In other words, choosing a smaller-sooner reward over a greater-later reward.

Studies have shown that heavy drinkers discount the future at rates far higher than light drinkers, smokers at higher rates than non-smokers, and heroin addicts at almost twice the rate of the non-addicted population. Moreover, the kinds of choices those who struggle with addiction face every day are complex rather than simple. Those in recovery are torn, not between rewards that differ in terms of time and quantity—such as our above choice between five dollars today and ten dollars next month—but between rewards that differ in terms of time and quality.

When Steven passed that bar, he weighed two alternatives: On the one hand, there was the drink, signifying immediate physical pleasure; on the other hand, something we might call “sobriety,” an abstract idea that may well be essential to the quality of Steven’s life, overall, but has no immediate utility and can only be experienced over time. Steven was faced with choosing between an immediate tangible reward and a later abstract one, between something concrete and something transcendent that emerges through interactions with others. After his rift with his boss and then his wife, that later, abstract, transcendent, people-oriented reward grew fuzzy and unpersuasive. Instead he chose the concrete pleasure of a drink.

He was also being tricked. The offer of a single drink to feel better now was really a bait-and-switch con. Alcoholics Anonymous (AA) has a great phrase, “one drink, one drunk.”  Most of those in recovery cannot have a single drink without restarting an unstoppable process. That single drink turned out to be the first step in an old, familiar dance, a leap into an automatic pattern of using. It would have been as hard for Steven to have a single drink as it would be for an ex-smoker to light up a cigarette and have a single puff.

AA has another great phrase: “The ‘ism’ of ‘alcoholism’ stands for ‘Incredibly Short Memory.'” For those of us who struggle with addiction, we need to remember again and again these twin ideas:

1. There is no one drink or one hit, only a pattern of use.

2. What we give up by taking that first hit may not be measurable, but it is of immeasurable value. By taking what is in a shot-glass or a syringe we lose ideas such as “joy,” “hope,” and “love;” hard-to-define words that have to do with what makes life meaningful.

© Copyright 2011 by Daniel Goldin, LMFT, therapist in South Pasadena, California. All Rights Reserved. Permission to publish granted to GoodTherapy.org.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • DT

    DT

    February 14th, 2011 at 11:54 PM

    I have not been close to any addicts personally but from what I’ve heard-Staying away after a recovery is far more difficult than the decision to go into recovery.It is not only hard to maintain but is constantly threatened by temptations such as the one mentioned here-Having one drink!

  • FalcoN

    FalcoN

    February 15th, 2011 at 7:38 AM

    Even the slightest of problems can prove to be a trigger to a relapse and I believe it is easier to suffer relapse when the recovery has not been too much into the past. But I see that sometimes it is possible even after a person has stayed sober for a long time.

    People around such a person can really help by lending a shoulder to lean on in times of trouble because it can well save the person from turning to his former addiction for solace.

  • vickie

    vickie

    February 15th, 2011 at 4:27 PM

    Why is it that some people so easily find sobriety while there are others who battle with it for the rest of their lives? I hate to read stories about people who have maintained sobriety for so many years having a relapse and basically having to start all over again. You never know what might trigger this kind of behavior and who it is going to strike.

  • Tina

    Tina

    February 16th, 2011 at 9:09 PM

    I’d like to know how it happens like that please. Is there still a physical need for alcohol lying dormant in your system somewhere that gets triggered? I can’t get my head around how one drink could send a man spiraling back into alcoholism. My husband hasn’t drank in twenty years and is a recovered alcoholic. He had been through treatment long before I met him. Now I feel a bit frightened. If it’s so easy to relapse that it could happen to us.

  • joanna

    joanna

    February 17th, 2011 at 12:26 PM

    This is proof that no matter what, if you’re a former alcoholic, avoid alcohol. No exceptions, no excuses. Ever. You can never assume you have a grip on it and can go back to drinking socially.

  • Jay

    Jay

    February 17th, 2011 at 5:51 PM

    Treat alcohol like the poison it is. That’s how best to view it. You wouldn’t willingly drink bleach, would you? Like they say at AA and on the article, one drink, one drunk. The man in the article was sober for fifteen years and one drink is all it took. I feel sorry for his family having to deal with that after all those years of sobriety.

  • Daniel Goldin

    Daniel Goldin

    February 17th, 2011 at 6:12 PM

    Hi Tina,

    Some speculate that dopamine centers of the brain — associated with sensations of reward — remain sensitised to drug cues from years of use. Whatever the physical basis, it seems that people in recovery often activate an habitual pattern of using when they have that “one drink.” That being said, many in recovery do not relapse. It helps to understand the “one drink, one drunk” principle.

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