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1. Apprehension About Well-Being. Alcoholics report an initial sense of fear and uncertainty. There is a lack of confidence in the ability to stay sober. This apprehension is often extremely short-lived.
2. Denial. Patients reactivate denial systems in order to cope with apprehension and resultant aniety and stress. The denial systems reactivated in this stage of the relapse dynamic tend to correspond with the denial systems utilised to deny the presence of alcoholism during the initial phase of treatment. Most patients aware of this denial with hindsight but they report that they are unaware of this denial process while experiencing it
3. Adamant Commitment To Sobriety. The patients convince themselves they will never drink again. This self-persuasion is sometimes overt and blatant but most often constitutes a very private desicion. Many patients report fear or apprehension of sharing that conviction with thier therapists or with members of AA. Once patients convince themselves they will never drink again, the urgency of pursuing a daily programme of recovery diminishes.
4. Compulsive attempts to impose sobriety on others. This attempt to impose sobriety of individual standards for recovery on others is seldom overt. It is generally private judgements about the drinking of friends and spouses and the quality of the sobriety programmes of fellow recovering alcoholics. When dealing with issues of sobriety, patients begin to focus more on what others are doing than on what they are doing.
5. Defensiveness. Patients report a noticeable increase in their defensiveness when talking about their problems or recovery programmes
6. Compulsive Behaviour. Behaviour patterns become rigid and repetitive. The alcoholics tend to control coversational involvement either through monoply or silence. The tendancy towards overwork and compulsive involvement in activities begins to appear. Non-structured involvement with people is avoided
7. Impulsive Behaviour. Patterns of compulsive behaviours become interupted by impulsive reactions. In many cass the impulse is overreaction to acute episodes of stress. There were also reports of impulsive acitivities being the culmination of a chronic stress situation. Many times these overreacions to stress form the basis of desicions which affect major life areas and commitments to ongoing treatment.
8. Tendancies Toward Loneliness. Patterns of isolation and avoidance increase. There are generally valid reasons and excuses for this isolation. Patients report short episodes of intense loneliness at increasing intervals. these episodes are generally dealt with by reactivating compulsive or impulsive behaviou patterns rather than pursuing responsible involvement with other people.
9. Tunnel Vision. Patients tend to view their lives in isolated fragments. They focus exclusively in one area, preoccupy themselves with it, and avoid looking at other areas. Sometimes proccupation is on the positive aspects thus creating a delusion of security and well being. Others occupy themselves with the negative aspects thus assuming victim positions, which confirms the belief that they are helpless and being treated unfairly.
10. Minor Depression. Symptoms of depression begin to appear and persist. Listlessness, flat affect, oversleeping become common.
11. Loss of Constructive Planning. Patients skill at life planning begin to diminish. Attention to detail subsides. Wishful thinking begins to replace realistic planning.
12. Plans Begin to Fail. Due to lack of planning, failure to follow through, lack of attention to detail, or the pusuit of unrealistic objectives, pland begin to fail.
13. Idle Daydreaming and Wishful Thinking. The ability to concentrate diminishes and concentration is replaced with fantasy. The if only syndrome becomes more common in conversation. The fantasies are generally of escape or of "being rescued from it all" by some unlikely set of circumstances.
14. Feeling That Nothing Can Be Solved. A failure pattern in sobriety develops. In some cases, the failure seems real in terms of objective realities; in other cases it is imagined and based upon intangibles. the generalised perception of "I have tried my best and it is not working out" begins to develop.
15. Immature Wish To be Happy. Conversationsl content and though patterns become vague and generalised. The desire to "be happy" or "have things work out" becomes more common without ever defining what is necessary to be happy or have things work right.
16. Periods of Confusion. The episodes of confusion increase in terms of frequency, duration and severity of behavioural impairment.
17. Irritation With friends. Social involement including friends and intimate realtionships, as well as treatment relationships formed with therapists and AA memebers, become strained and conflictual. The conflictual nature increases as confrontation of the alcoholics progressively degenerating behaviour increases.
18. Easily Angered. Episodes of anger, frustration, resentment, and irritability increase. Overeaction becomes more frequent. Often fear of extreme overreaction to the point of violence, seriously increases the level of stress and anxiety.
19. Irregular Eatin habits. Patients begin overeating or under-eating. The regular strcuture of meals is disrupted. Well-balanced meals become replaced by less nourishing junk food.
20. Listlessness. Extended periods of inability to initiate action develops. These are marked by inability to concentrate, aniety, and severe feelings of apprehension. Patients often report this as s feeling of being trapped or by having no way out.
21. Irregular Sleeping Habits. Episodes of insomnia and nights of restlessness, fitful sleep are reported. Episodes of sleeping marathons of 12 to 20 hours are reported at intervals varying between 6 and 15 days. These sleeping marathons apparently result from exhaustion.
22. Progressive Loss of daily Structure. daily routines become haphazard. regular hours of retiring and rising disappear. Complaints of inabaility to keep appointments become more common and social planning decreases. patients report feeling rushed and over-burdened at times and then face large blocks of idle time in which they do not know what to do. An inability to follow through on plans and desicions is also reported. The patients report they know what they should do but are unabale to overcome strong feelings of tension, frustration, fear or anxiety that prevent them from following through.
23. Periods of Deep depression. depression becomes more severe, more frequent, more disruptive, and lingers in duration. These periods generally occur during non-structured time, complaints that nobody cares.
24. Irregular Attendance at Treatment meetings. Attendance at AA becomes sporadic. Therapy ppointments are scheduled and then missed. Attendance at treatment groups and home AA meetings become more sporadic. ratinalisation patterns develop to justify this. The effectiveness of AA and treatment is discounted. Treatment loses a priority ranking in the patients value system.
25. Development of an "I Don't Care" Attitude. Patients generally reporting this "I don't care" stance masks a feeling of helplessness and extremely poor self-image.
26. Open Rejection of Help. Patients cut themselves off from viable sources of help. This is sometimes accomplished dramatically through fits of anger or open disputes. Other times it is done through quiet withdrwal.
27. Dissatisfaction With Life. patients begin to think " things are so bad now I might as well get drunk because they can't get worse." rationalisation, tunnel vision, and wishful thinking begin to give way to the harsh reality of how totally unmangeable life has become in the course of this period of abstinence.
28. Feelings of Powerlessness and Helplessness. This is marked by an inability to initiate action. Thought processes are scattered, judgement is distorted, and concentration and abstract thinking abilities are impaired.
29. Self Pity. patients become indulgent in self-pity. This is often called the PLOM (Poor Little Old Me) Syndrome. This self-pity is often used as an attention-getting device at AA and with familyt members.
30. Thoughts of Social Drinking. The patient thinks that drinking can normalise many of the feelings they are experiencing.. The hope that perhaps they can again drink in a controlled fashion begins to emerge. Sometimes the thought is challenged and put out of concious thought, other times it is entertained. Again, with hindsight, the patient realises they had other alternatives besides drinking, however at the time, they felt they were facing a choice between insanity, suicide or a return to drinking.
31. Concious Living. Denial and rationalisation become such extreme processes that even the alcoholics begin to recognise the lies anddeceptions. In spite of this recognistion, they feel unable to interut the pattern.
32. Complete Loss of Self- Confidence. The patients feel they cannot get out of this trap no matter how hard they try. They become overwhelmed by the inability to think clearly or initiate action.
33. Unreasonable Resentments. The patients feel severe anger with the world in general and are unable to function. This anger is sometimes generalised; at other times it is focussed at particular scapegoats; at other times it is turned against themselves.
34. Discounting All Treatment. Attendance at AA stops completely. healthy relationships are strained and eventually terminated. patients who take Antabuse report episodes of forgetting to take it or manipulating to avoid taking it regularly. patients drop out of treatment in spite of a realisatin that they are acting irrationally and need help.
35. Overwhelming, Loneliness, Frustration, Anger and Tension. The patients reports feeling totally overwhelmed and feeling there is no available option except returning to drinking, suicide, or insanity. The fear of insanity is intense. There are also intense feelings of helplessness and desperation. Often drinking is an impulsive behaviour with little or no concious preplanning.
36. Start of Controlled Drinking. The efforts at control take two general patterns: the effort to control quantities while drinking on a regualr basis or the effort to engage in one short-term and low-consequential binge.
37. Loss of Control. The ability to control is lost, sometimes very quickly, sometimes after varying patterns of controlled drinking. Once the patient returns to alcoholic drinking, it is marked by symptoms as severe or more severe than the previous episode of active alcoholism.

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