Triggers and addiction are inexorably linked. Even so, the chain reaction of craving, urges and rela...

1. Alcohol, Drug Addiction and Recovery News
Triggers and addiction are inexorably linked. Even so, the chain reaction of craving, urges and
relapse can be broken. First, one has to develop the ability to identify the unique triggers that
precede a fall. The stressors can be simple or complex. The experience is often a shock. It may seem
to come out of the clear blue or reveal itself as a growing sense of unease that intensifies.
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

2. 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:
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

3. 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.
I read a book by Pema Chodron called When Things Fall Apart that said, 'When you are present and
aware emotions have a very short half life. When you aren't they can last for years.' That insight was
very powerful for me."
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.

4. 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.
The seven deadly sins are examples of triggers in action. Our reactions to the things that irk us have
more to do with our internal conflicts than anything else. Once we wrap our heads around that and
develop the ability to be accountable for what we do, we're on the path to managing our demons. We
may never slay them or be examples of compassion and chivalry every day, but it's a worthy
beginning.
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."
Check out this free download of the song Trigger by Clara Venus.

5. Dawn Roberts is a writer and media consultant in New York. Follow her on Twitter
@SilverHolloMuzo
"The urge to drink or drug is not an enemy to be summarily vanquished but a signal to ferret out the
root cause." Lance Dodes, M.D.