Myths and Cognitive Distortions Associated with Slips, Lapses, and Relapse

Emotional or stressful states, such as depression, anxiety, or anger, are maintained or increased by
distortions in thinking, which are often referred to as cognitive distortions.

Everyone uses cognitive distortions, but individuals who have experienced numerous losses or painful
experiences, such as those who have an addiction to alcohol and other drugs, tend to rely more on these
cognitive distortions over time as the losses or bad experiences start to add up. In other words,
individuals who have experienced a long series of negative experiences (i.e., defeats in life), tend to be
guided more by cognitive distortions.

Cognitive distortions are not based in facts or current thinking, but rather on select memories of past
events (again, mostly the negative events or losses). These distortions are negative filters or lenses
through which individuals with extensive losses tend to view their abilities. For example, a common
cognitive distortion is to assume that you will fail at a new task, because you have failed at similar tasks
in the past. The distortion is that you don’t consider current facts, but rather rely only on one or two past
failures, even though you may have succeeded at the task on numerous occasions or are fully capable of
completing the task. Another example is that you ignore the nine things you achieved, did correctly or
performed well in a day and, instead, focus on the one mistake or error in performance that you made in
the same day. Perhaps the most common distortion is known as the all-or-nothing thinking, which
occurs when you assume that you either have to achieve an objective or complete a task to perfection or
you cannot even attempt the objective. Your assumption is that you have to have to achieve a 100%
correct or not at all. The distortion almost always leads to inaction or a state of immobility because you
can never achieve 100% perfection. Distortions are your exaggerated views of past failures that block
your view of current factual information about actual skills, current progress, successes, and capacities.

A common distortion used by individuals in early recovery is known as the abstinence violation effect or
AVE. This distortion is based on a collection of cognitive distortions, including all-or-nothing thinking
and “should” statements (e.g., I should be able to resist drugs or I should no better than to use alcohol or
drugs). The distortion is used when you have a slip or lapse and immediately assume that your recovery
has been destroyed, and you have lost everything in terms of treatment knowledge, skills or ability to
abstain. People who are influenced by the AVE will keep drinking or using drugs, even though they
have the capacity and skills to stop. Once the AVE distortion is used, you feel that you have lost
everything and have nothing to gain by stopping, so you proceed toward drowning yourself in alcohol or
drugs.

Fortunately, you can learn to control or counter your cognitive distortions. As noted, everyone uses
cognitive distortions at some point, but most individuals are not influenced by these distortions. You
can learn how to use logic and factual information to counter cognitive distortions and identify more
rational interpretations of events, including dealing with a slip or lapse in drinking alcohol, smoking
cigarettes or using other types of drugs.

The first step is to understand your cognitive distortions as well as commonly held myths about alcohol
and drug use patterns.
The following table provides a detailed description of common held myths and distortions associated with
urges, cravings, slips, lapses or relapse with alcohol and other drugs. The first column provides a listing of
common myths. The second column identifies common cognitive distortions that people tend to rely on to
support each myth. The third column includes factual informational about urges, cravings, and slips or lapses of
alcohol or drugs.
Updated on January 31, 2011
1
Myth or distorted
view of slips,
lapses and relapse
I should be able to
abstain from alcohol
and drugs through
willpower and desire
Urges and cravings to
use are a result of the
biological disease of
addiction and come
from internal states
(e.g., physiological
reactions)
Cognitive
distortion
AVE, all-ornothing
thinking, &
should
statements
All or nothing
thinking,
overgeneralizing,
or jumping to
conclusions
My expectations of the
benefits associated with
alcohol and other drugs
are accurate because I
have used them for
years
I should be able to stop
drinking or using drugs
by thinking about all
the negative thinks that
will happen to me if I
use them. I can stop by
thinking about the
punishment
Updated on January 31, 2011
Should
statements,
Polarized or
dichotomous
thinking
Factual Interpretation
Many people think that addiction is an immoral behavior that can be stopped through
willpower and desire. Instead, addiction is difficult to stop because you have performed
the behavior hundreds or thousands of times and have conditioned your brain to respond
to alcohol and drugs in certain situations (known as high-risk situations). Any behavior
that you repeat a thousand times and always leads to an immediate pleasant outcome;
e.g., feeling high, stopping anxiety, or medicating pain, will be extremely difficult to stop.
This is why millions of Americans overeat and overspend with credit cards, because the
behavior leads to an immediate and pleasant outcome, even if it will also lead to a
negative outcome over time (e.g., gaining weight or large credit card bills). In fact, your
brain becomes hard-wired to repeat the behavior in the presence of a high-risk situation or
triggers, even when you try to stop. People are able to learn how to stop the behavior
over time, but through skills training, not willpower. Everyone has the desire to stop
drinking or using drugs, but only those who acquire the skills to manage high risk
situations or avoid certain triggers, will be more likely to abstain from alcohol and other
drugs over time.
Nearly all urges and cravings are triggered from external cues (i.e., triggers in the
environment), not biological states. Physiological withdrawal tends to subside within a
few days to a few weeks, but environmental triggers can last for years. Nearly all
ongoing triggers are from cues or high risk situations that are controllable or avoidable.
You can learn to reduce your urges or cravings over time by identifying all the cues and
high risk situations under which you learned to drink or use drugs.
Our brains are conditioned to remember the association between drinking or drug use and
pleasant outcomes through repeated use; however, our perception of the benefits
associated with alcohol and drugs tends to exceed the actual benefits. This is the same
phenomenon that occurs when recalling a pleasant experience in the past, such as your
first love, a vacation, or past relationships that have ended. We have a tendency to
exaggerate and overstate the positive side of our pleasant experiences in the past, just like
we have a tendency to exaggerate and overstate our negative experiences. Alcohol and
other drugs do provide rewarding outcomes, but these expected outcomes tend to exceed
the actual outcome. For a person in recovery, it will help if you can identify the actual
benefit of alcohol and other drugs from your perceived and romanticized view of these
substances. You will find that you will be able to reduce your urges over time by
examining the actual rewards provided by these drugs; i.e., it’s rarely as good as you
think. Write down the actual amount of benefit that you will receive from alcohol or
other drugs, including the amount of time that you are “high”, social, relaxed or feel no
pain. In addition, write down how long it takes before you begin to feel the punishment
side of alcohol and drugs. Record your actual experiences soon after you use these
substances. Keep these lists with you when you want to use in the future (make sure you
know what you are getting before use again)
It is a good idea to keep a list of all the bad thinks that will occur if you return to using
alcohol or drugs, but it is also important to know that nearly all slips, lapses, or full
relapses occur because of the immediate rewards that you will receive from alcohol or
other drugs. Urges and cravings come from conditioned memory banks in your body and
brain that recall rewarding outcomes associated with using alcohol and other drugs. As
noted above, it is human nature to select behaviors that lead to immediate rewards, even
if there is a delayed punishment associated with the behavior. It is helpful to avoid
situations where you may want to use alcohol and other drugs, but it is also helpful to find
other, healthier behaviors that can lead to the same rewards provided by alcohol and other
drugs. Just focusing on the negative aspects of alcohol or drugs, may not be enough to
keep you from experiencing a slip, lapse or full relapse.
2
Myth or distorted
view of slips, lapses
and relapse
Cognitive
distortion
Factual Interpretation
Persistent or ongoing
urges and cravings are
indications that treatment
is not working or the
disease of addiction is too
difficult to overcome (e.g.,
I will always be a dopefiend or drunk)
If I no longer desire or
have urges to use alcohol
and drugs while I am in
residential treatment, I will
no longer desire or have
urges to use these
substances when I leave
treatment
All or nothing
thinking,
should
statements,
emotional
reasoning, &
abstinence
violation effect
It is natural and normal reaction to have ongoing urges and cravings if you continue to
encounter cues and high risk situations where you use to drink or use drugs. Urges to
use are natural if you had extensive experiencing using alcohol and other drugs.
Indeed, the longer you learned to use alcohol and drugs, the longer it will take to learn
new connections. Being aware of urges can be extremely useful in helping you
identify the ongoing cues or high risk situations. You can lower your urges and
cravings over time, by learning to control, remove or avoid cues and high risk
situations.
All or nothing
thinking,
should
statements, &
AVE
The reasons most people stop feeling urges to use while in treatment are because they
no longer see the cues that remind them to use and they no longer encounter the high
risk situations where they are more likely to use. Moreover, the reasons most people
start feeling urges to use when they leave treatment is because they begin to encounter
these cues and high risk situations where they use to use alcohol and other drugs.
Experiencing urges after treatment is normal and expected, even if you stopped
experiencing these urges in treatment
As noted, urges/cravings are nothing more than signals that you have encountered a
cue in the environment that reminds your brain or body of past drinking and drug use
behaviors (e.g., entering a bar will remind you of past behaviors of drinking beer).
Instead of giving into your urges, develop a healthy sense of detachment to the urge
and understand it from the environmental trigger, rather as a sign of weakness. Use
the urge to identify the cue and set up a plan to deal with the cue or high-risk situation.
In addition, everyone can learn how to ride through the urge like riding through a
wave in the ocean. The wave will rise, peak in seconds or a few minutes, and
eventually pass through you in minutes. You can learn to surf through the wave of
urges. The longer you can surf through an urge, the easier it will be to resist using
alcohol or drugs in the future. You can control your body’s response to urges.
If I feel an urge or craving,
I must want to get drunk
or get high and I should
therefore give into my
urges
I can reduce my urges by
using now and then; in
other words, I need to give
into my urges or cravings
to lower the intensity of
the urges over time
I cannot quit smoking
cigarettes while I’m
learning how to quit
drinking or using other
drugs. If I quit cigarettes
now, I will likely fail at
abstaining from other
drugs
If I experience a slip or
lapse, I have lost control
of my recovery and I
cannot regain the control
Updated on January 31, 2011
Emotional
reasoning,
overgeneralizing,
& should
statements
Dichotomous
thinking
Dichotomous
thinking, all or
nothing
thinking, &
catastrophizing
AVE,
catastrophizing
, & all or
nothing
thinking
Your brain and body develops connection between alcohol/drugs and the rewards that
come with these substances. The longer you can go without using alcohol or drugs,
the more likely you will be able to break the connection between the drink/drug and
reward connections in your brain. In other words, the intensity and frequency of urges
will decrease over time the longer you go without using these substances. Using
alcohol, cocaine, pot or cigarettes now and then will help to maintain the connection in
your brain between the substance and the rewarding feelings. In other words, the
intensity and frequency of the urges will remain strong the more use alcohol and other
drugs over time.
This is one of the most common myths in addiction treatment and is often promoted by
counselors who continue to smoke themselves. Cigarette smoking is one of the
strongest triggers to drinking alcohol, smoking marijuana/pot, or smoking cocaine.
People who complete addiction treatment, but continue to smoke cigarettes are more
likely to return to a full relapse of their drinking or drug use patterns compared to
individuals who either quit cigarettes in treatment or never smoked cigarettes. People
who quit smoking cigarettes are actually more likely to complete treatment, maintain
longer periods of abstinence, reduce depression and anxiety, and live longer. 51% of
people who enter an addiction treatment program will die of cigarette smoking, not
from their drug of choice.
Abstinence can be regained the second after you stop consuming alcohol or other
drugs. All individuals can stop using, once they started drinking alcohol or using other
drugs. You are more likely to regain control of your recovery plan as you develop
skills to manage slips or lapses. Over time, you will likely reduce the number of slips
that you experience as you enhance your skills at identifying drinking or drug use
triggers and manage or avoid high risk situations. Returning to a full relapse is a risk
of using alcohol or other drugs, but it is not an uncontrollable and inevitable outcome
of a slip.
3
Now that you have reviewed the list of common myths associated with recovery, write down a list of possible
alternatives to the myths that have influenced your drinking or drug use patterns in the past. It is not necessary
to identify an alternative plan for all the myths, just the ones that have impacted or undermined your attempts at
recovery in the past or could be a barrier to your recovery now.
Myth or distorted
view of slips, lapses
and relapse
Cognitive
distortion
I should be able to abstain
from alcohol and drugs
through willpower and
desire
AVE, all-ornothing
thinking, &
should
statements
Urges and cravings to use
are a result of the
biological disease of
addiction and come from
internal states (e.g.,
physiological reactions)
All or nothing
thinking,
overgeneralizing,
or jumping to
conclusions
My expectations of the
benefits associated with
alcohol and other drugs
are accurate because I
have used them for years
I should be able to stop
drinking or using drugs by
thinking about all the
negative thinks that will
happen to me if I use
them. I can stop by
thinking about the
punishment
Persistent or ongoing
urges and cravings are
indications that treatment
is not working or the
disease of addiction is too
difficult to overcome (e.g.,
I will always be a dopefiend or drunk)
If I no longer desire or
have urges to use alcohol
and drugs while I am in
residential treatment, I will
no longer desire or have
urges to use these
substances when I leave
treatment
If I feel an urge or craving,
I must want to get drunk
or get high and I should
therefore give into my
urges
Updated on January 31, 2011
Alternative Plan or Interpretation
Should
statements,
Polarized or
dichotomous
thinking
All or nothing
thinking,
should
statements,
emotional
reasoning, &
abstinence
violation effect
All or nothing
thinking,
should
statements, &
AVE
Emotional
reasoning,
overgeneralizing,
& should
statements
4
Myth or distorted
view of slips, lapses
and relapse
I can reduce my urges by
using now and then; in
other words, I need to give
into my urges or cravings
to lower the intensity of
the urges over time
I cannot quit smoking
cigarettes while I’m
learning how to quit
drinking or using other
drugs. If I quit cigarettes
now, I will likely fail at
abstaining from other
drugs
If I experience a slip or
lapse, I have lost control
of my recovery and I
cannot regain the control
Updated on January 31, 2011
Cognitive
distortion
Alternative Plan or Interpretation
Dichotomous
thinking
Dichotomous
thinking, all or
nothing
thinking, &
catastrophizing
AVE,
catastrophizing
, & all or
nothing
thinking
5