How to Stay Sober: Chuck, Janet

A Habitual Relapser

"Chuck has a severe addiction to alcohol and has for many years. When Chuck drinks, he picks up a beer and doesn't stop until the binge ends," Janet says about her husband of two years.

"My daily consumption was three to four six-packs of beer per day," Chuck says.

"When I married Chuck, I knew he was an alcoholic, but he had been sober almost a year. I had no idea the severity of his addiction," Janet says.

"Being a therapist, I really have to separate my alcoholism from my role as a therapist. It's like Dr. Jekyll and Mr. Hyde. I don't have the ability to stop it," he says.

"It surprises me how much he's relapsed in the past two years," she says.

"I cannot say that one specific thing triggers me, because I drank when I was happy, I drank when I was mad, I drank when I was depressed, I drank when I was celebrating," Chuck says.

[AD]"When Chuck drinks, he goes away for days at a time, binging, staying drunk the entire time he's gone," Janet says. "Chuck has had multiple DUIs over the years, and he's been through rehab several times. Every time Chuck relapses, it tends to get worse. Chuck has lost two jobs in the two years we've been married because of his alcoholism. Chuck is not a nice drunk. He lashes out at me to hurt me, tells me I'm a horrible mother, tells me how fat I am."

"I think that if I relapse again, I will definitely lose my marriage," Chuck says.

"One more relapse, and it could be the last for him," Janet says.

"You're 90 days sober at this point. Congratulations on that. That's no small accomplishment, obviously. I'm pleased for you," Dr. Phil tells Chuck. "You're worried that it's not going to stick," he says to Janet.

"Absolutely, I'm worried," she says.

Chuck is worried as well. "I know the more that I relapse, the harder it is when I come back to try to stay sober," he says.

"Let's just talk shop for a minute here, one shrink to another," Dr. Phil tells Chuck. "Do you think because of your profession, and education and training that you pretty much know the basics about this?"

"Dr. Phil, I have to be honest with you. I thought I did, but I don't. There's so much more I could learn," he says.

Dr. Phil explains that when he first learned that Chuck was a therapist, he groaned and said, "Oh, no. Not one of those." "The reason I said that is because sometimes a therapist can know just enough to be dangerous," he says. "But you consider yourself high risk?"

[AD]"Oh, yes, definitely, because in my past, I have been able to maintain [sobriety] a certain length of time," Chuck says. He once went three years without a drink of alcohol.

Dr. Phil commends Chuck for going to Alcoholics Anonymous meetings. "I think it is a wonderful program and support group. I think Al-Anon is important. You are an alcoholic, correct?"

"No doubt about it," he says.

Dr. Urschel says, "This is a chronic medical disease. I want to make sure everybody understands: This is a chronic disease. This isn't going to go away, so you have to treat it as if it's not going away, just like diabetes or high blood pressure. You're in this. You both are in this, and your kids are in this for the long haul."

Dr. Phil explains that addiction is a complex disease which is resistant to treatment and subject to relapse. "Frankly, I know this isn't what anybody wants to hear. Janet, I know it's not what you want to hear, Robin, I know it's not what you want to hear, but relapse is part of the disease process," he says. He asks Chuck, "You say you know what your triggers are? What would be your number one?"

"Going to a place that serves alcohol, such as a bar," he says.

"So, that's an easy one because you can stay out of those places. What are the emotional triggers?"

"I'm an alcoholic. I drink for everything. I tend to drink a lot more when I'm feeling guilty," he says. "But I also drink when I'm happy, to try to make it " "

"To make it happier," Dr. Phil finishes.

"Happier," he says.

[AD]Dr. Urschel stresses the importance of an addict identifying his or her triggers. "The triggers basically are things in the environment or internally, like depression and anxiety, that set off, in the injured part of the brain, electrical impulses, and we experience them as cravings. The thing about cravings is the addict or alcoholic understands, ‘If I have a craving, I have to use.' That's actually not true. The craving itself will go away if you just distract yourself within 15, 20 minutes. At the time, again, people don't understand this, that craving is a physiologically-generated signal coming out of the deepest part of your brain that is driving you to use. So, the triggers are things that activate the cravings. So, you need to identify your top 20, top 25 triggers on a weekly basis because they'll change. The longer you stay sober, the fewer triggers you have in the environment, the fewer cravings you'll have. And then you stay away from those places to the extent that you can, and then all of a sudden, you just made it a lot easier. It's those kind of easily doable things that you do, combined with the medication, psychiatric medications if indicated, and 12-step programs, getting a sponsor, all that comes together, and you can really have a great deal of success."

Dr. Urschel says a relapse contract is also important. "That's where the alcoholic or addict sits down with their significant other, and the addict actually participates in figuring out each time you relapse, you need to be figuratively slammed to the floor. You need to feel pain from the relapse. One of the things enablers do is prevent the alcoholic from feeling the pain from a relapse " They get rid of the consequences of the relapse. So, you need to come up with the top three things that will hurt: ‘If you relapse, you're not going to come back to the house for three days, you can't see the kids, you have to go to three meetings a day and get signed by your sponsor that you were at those meetings' and do several other things. After that, if you relapse again, maybe you're out of the house for a month. If you relapse again, maybe it's a formal separation. But this is something you would write down on a piece of paper, you work on and you talk about. What is going to hurt you most? How are you going to feel the worst pain from a relapse? You agree this is what's going to happen, and this is in writing so you two can't back out of it. You can't give in, because they'll manipulate you: ‘Oh, I don't really want to do that.' ‘Hey, here it is in writing.' And now all of a sudden you have severe, very painful consequences, and that pain is customized to you all."

"And this is as important for your wife as well as it is for you," Dr. Phil points out, adding that the relapse contract helps loved ones feel less helpless.

[AD]Dr. Phil commends Chuck for the work he's doing, like individual and marital counseling, getting a psychological evaluation and going to Alcoholics Anonymous meetings. He also recommends his guests make a commitment to healthy living in other ways, such as exercise.

Dr. Lawlis adds, "Physical exercise is actually better for depression and anxiety than psychotherapy, because it activates internal restoration, and it also creates a stronger mind, in terms of its connections, and it helps you breathe, so you can actually feel more energy when you need it."

Dr. Phil reviews some action steps to take if you think your loved one is an addict:

Addiction Action Steps:

- Assist, not enable
- Use a structured intervention
- Set your team
- Confront factually
- Get commitment from addict
- Be willing to let the addict go
- Have a plan

[AD]"You need to choose to assist but not enable the person you're trying to help, and there's a big difference there," Dr. Phil says. "Use a structured intervention to lead the addict to the help that they need to begin recovery. To do that, you need to set your team. Get a group of concerned people, maybe family members, maybe others, who are not afraid to look the addict in the eye and tell them that they need help. You should confront factually but with love, care and concern. This isn't a big drama scene. It may be a good idea to bring a written list of data to help explain the consequences of the drugs or the alcohol that the addict is abusing. Be sure to remember, though, that you're talking to the drugs, not the person. If you've got somebody who is actively using, then I promise you, they're in an altered state of awareness, and you need to recognize that. The substances take over an addict, causing, oftentimes, paranoia, anger and certainly a huge dose of denial. Get a commitment from the addict to go to treatment or be prepared to break contact. There has to be a consequence. Be ready to let the addict go if they refuse treatment. And, you should have a firm, immediate plan that you can react to if and when they say, ‘Yes, I'll get help.' Do that ahead of time. Addiction is a chronic disease that you just can't break on your own."