Fighting Addiction Triggers

Psychiatrist Dr. Chad Coren defines a trigger as “Any high-risk situation or stressor that sparks off a thought, feeling, or action to use drugs or alcohol. This spark, which is experienced as a temptation to use, is called a ‘craving’ or ‘urge.’ Triggers lead to cravings, and urges to use.”

Things that trigger us come from within and without. For the sake of clarity, I’ll break them down with the help of The Addiction Recovery Guide section on relapse prevention.

Some examples of external triggers:

People:

• An old friend who you drank and used with makes contact and wants to “party”
• A connection who sells his medication contacts you
• Running into a former drug dealer unexpectedly

Places:

• Business requires attending a club you once drank or used at
• Your living room couch that had been a favorite spot to nod out
• Driving by the neighborhood you once scored drugs in

Things: 

• A half-full bottle of alcohol on a table
• Painkillers unattended in a medicine cabinet
• Smoking paraphernalia at a clothing boutique

Situations: 

• Celebrations, holidays or sporting events
• Emotionally charged interactions—arguments, criticism, upsetting news
• Times of day that one associates with a regular drink, drug or smoke

Internal triggers

Internal triggers can be sense memories, feelings or thoughts.

Physical sensations:

• Pain, fatigue, panic

Thoughts: 

• I can’t have physical intimacy without using
• I haven’t used in a year, I’m not an alcoholic anymore
• Concerts aren’t fun without getting stoned

When people experience triggers their thinking gets hijacked. They may experience a combination of fear, anger and despair. They may also start to think they’re not doing recovery right. Constant cravings can lead to frustration with and abandonment of the path to recovery altogether.

Managing triggers requires the willingness to look at our actions, peering below the surface. Certain scenarios or people set us off, and the results aren’t pretty. The stress, conflict and resulting pain become unsustainable. While examining unchecked emotions is a messy business, is there really an alternative?

The things that irritate us the most, that take us from zero to 60 in a flash are exactly the ones to slow down and have a look at. There are some sure signs that you’ve been punked by a trigger. Aggression and rage are the type of explosive emotional responses that exemplify the domino effect a trigger can set off.

Evan Haines, who founded Acadia Malibu and is in recovery, shared some of his thoughts on triggers. He spoke with me about how the rehab process can help clients to have a better understanding of what lies beneath this complex phenomenon.

“People who go to rehab begin to understand how their early life experiences have defined how they respond today. In treatment, we can look at how we got that way, but also to come into the present moment, to become mindful, and to breathe. It’s a lifelong journey. The awareness begins with looking at the riddle of addiction and recovery, I am interested in what the pre-frontal cortex does with regard to impulse control, communication and decision-making.

We have the ability to see ourselves becoming emotionally disturbed. The more aware I am as an observer, I become more mindful and aware in general. My life-long goal is to be cognizant of programming that began from the moment of conception. We are hardwired to react to certain situations in specific ways. Animals live spontaneously, humans have their ‘lizard brain,’ but we can use our powers of communication and decision-making to take contrary action to urges.

When someone or something triggers me, I look at what part of myself it represents. Sometimes, it can arise from early childhood conflict.

“When you are present and aware emotions have a very short half life. When you aren’t they can last for years.” – Pema Chodron

How To Avoid Relapse Triggers

Psychotherapist Rose Sokol of Los Angeles offers some very useful advice regarding triggers and relapse. Here are her thoughts:

How can one identify a trigger before relapse?  

“I have found the triggers before a relapse begin with stress and anxiety without the resources (coping skills) to manage them. Once triggered, the client feels justified and rationalizes the relapse. Emotional triggers can include unrealistic expectations in early sobriety, depression, and self-pity. More concrete triggers can include situations, locations and people.

An example of a trigger is putting oneself in a situation or a location that was familiar and common when using. One can go to a bar they used to frequent when using and hang out with old drinking friends vowing to only have soft drinks. Once in the situation, an overwhelming amount of anxiety brings on a craving and there seems to be no defense against the first drink.

A wise therapist once said to me, we can’t take something away from someone (e.g., a drug, or drink for the alcoholic) without putting something in its place. Therefore, stress and anxiety for a sober person without learned coping skills (via psychotherapy, 12-step programs or support groups) may lead the clients to use a substance to find relief.

By identifying triggers before a relapse, one creates the space to reflect, and triggers can be avoided in the future. If an environmental factor exists such as the workplace, and it cannot be avoided, close contact with one’s therapist or chosen support group can be critical to managing the stress that leads to the trigger and ultimately, maintaining abstinence from drinking/using.”

What are the symptoms that something or someone is a trigger?   

“Many symptoms of triggers manifest by engaging in behaviors that bring on stress/anxiety. If one is not participating in meetings or receiving support, the trigger can be overwhelming. The non-supported, non-processed stress/anxiety combination is dangerous and detrimental. Also, old behaviors are big triggers, for example, calling an old using friend when lonely or stressed.”

What can a person do when triggered?

“Go to a meeting, call one’s therapist or sponsor and ask for help and direction. Once the trigger, thought or situation has passed without drinking or using, reflect on it and figure out how to prevent repeating the situation. Ongoing psychotherapy can be a real key in discussing triggers and working on behavioral goals and thought processes to prevent the stress/anxiety/using cycle.

By identifying your own unique triggers you can learn to change your reactions and create a plan to counteract them.

I think of triggers as a tap on the shoulder from the monster under the bed. A phantom whispering, ‘I’m here, and I will always be here.’ Falling into an emotional blackhole is just other version of Russian Roulette, I might not live to tell the tale. In early recovery, someone who bugged the hell out of me had a saying that rings in my ear to this day, she said, “The road becomes narrower.” At the time, it was another slogan whose implications escaped me. I was loathe to be reminded that my behavior options were going to be further curtailed.

Two decades later, I understand. If I walk through the world with narcissism masquerading as bravura or avarice as ambition, I’ll be miserable. Misery can be a trigger. Furthermore, being present and conscious today comes with an inconvenient clause: conscience. When I act in a manner inconsistent with my moral compass, the recoil lingers. I’ll put the bad deeds on blast when I ought to be sleeping. The thoughts come uninvited and replay themselves in an infinite loop. Self-loathing is another trigger.

From reading the work of Gabor Mate on the link between trauma and addiction, I believe that pain and stress are at the heart of triggers. Addictive behavior reveals itself as a self-soothing mechanism. This tells us that in recovery we have to watch out for swallowing (or wallowing in) pain.

Emotional pain is my own strongest trigger. Recently, I took a friend’s kids to play while she was in the hospital. I sent a text and a few pictures with a happy caption. She called after I dropped them home and gave me some dire news. This loving and brave woman is going to die. I was choked by anxiety and a hollowed-out feeling in the center of my gut. Suddenly, desperately, I wanted to use.

In that moment my mind raced through all the potential options. Time slowed down and I reflected on this toxic wishful thinking. Fortunately, I was able to ask for support, put my feelings into words and cry it out until I could pull myself together and move forward.

I used to think of triggers in the simplest terms, things other people did that pissed me off. When I dug deeper, I saw that my reactions were the effect rather than the cause of past provocations. Most of us are put off by arrogance, condescension and duplicity. But how about the passive aggressive, the eternal victim or the flaky friend? Our reactions to these arise from a single source, fear and threats to our security. The things that get under our skin reveal our secret histories as surely as any Jungian mirror.

No matter how long you have been in recovery a trigger can come along and blow you away. They are treacherous, difficult and awkward. Looking at them can be embarrassing, and being reminded of them makes us squirm. Knowing we cannot control other people, places and things is a start. Taking action when slippery situations arise, and reaching out for help is the best insurance available for maintaining sustained recovery from addiction.”