Relapse Dreams

A Hidden Message?

By Charles Gillispie, MFA, LISAC

Jean, a patient in treatment for substance abuse, came to my group disturbed about the following “using” dream she had the night before: I dreamed I was in the cafeteria teaching other patients here how to chop lines of cocaine and snort them. Though she laughed at the dream because of its ridiculous plot, Jean also wondered what it might mean, if anything, about her recovery.

The value of dreams

The purpose of this article is to briefly outline some of the clinical research that’s been conducted about the occurrence, meaning and value of drug-using dreams. It is my intention to demonstrate that drug-using dreams can be useful in counseling when clients and clinicians are informed about the possible function this type of dream serves.

One study, a classic in the field of substance abuse treatment, demonstrates that alcoholics who dream about drinking during the course of treatment tend to achieve longer periods of sobriety (Choi, 1973). This finding suggests that clients like Jean who dream about the substances they are attempting to abstain from may be more engaged in the treatment process than those patients who don’t report drug-using dreams. In other words, these clients take their struggle with substance abuse seriously enough to dream about it at night. As Freud observed, only matters of greatest importance are permitted to disturb our sleep. In this regard, Jean’s drug using dream may be understood as a positive sign, dreamed by a person who is seriously concerned about the consequences of relapse.

A more recent study of crack cocaine addicts who dream about drug use demonstrates that the content of using dreams is also important in predicting treatment outcomes (Reid, S. and Simeon, D., 2001). Over a ninety-day period, clients who report their dreams changing from using cocaine to actively refusing cocaine tend to achieve longer periods of abstinence. This finding suggests that readiness for change is reflected in dream content and that dream-life can provide clients with an opportunity to rehearse change. These dreams provide clients with an exposure to cravings, interactions with “using friends” and typical scenarios they will be confronted with in waking life after leaving treatment.  In these cases, the importance is not placed on the individual dream but the manner in which dream content shifts over time. If clients like Jean continue to dream about using substances, they should be encouraged to record their dreams and note any shift in content. This process may instruct clients and counselors about significant triggers that need to be addressed, while challenging clients to examine their readiness to change.

One particularly useful study of drug-using dreams demonstrates that a client’s personal response to the dream is more important than dream content when it comes to predicting a positive treatment outcome (Brown, 1985). The study finds that clients who dream about using substances fall into two main categories: one group experiences frustration that their dream isn’t real and the second group experiences relief that their dream isn’t real. The first group is described as having relapse-pending dreams. This group longs to re-experience intoxication and feels triggered toward substance use. The second group is described as having recovery-affirming dreams. This group wakes up disturbed by their dreams and feels repulsed from actual substance use. Clients like Jean clearly belong to this second group and often need help perceiving their using dreams as a recovery-affirming process. They may find it helpful to inventory their motivations for recovery and review their action plan. The using dream can be harnessed as a “wake up call” challenging clients like Jean to re-examine their assumptions about recovery.

Dreams relevant messages

Clients with relapse-pending dreams will also need help in regard to receiving a relevant message from the reactions they have to their using dreams. Counselors can direct these clients back to interventions that address the contemplation stage of change. These clients may benefit from a review of the costs and consequences of their substance use.

The relapse-pending dream may bring to light their impoverished view of sobriety. Counselors can challenge these impoverished views and direct clients toward new behaviors that excite and stimulate recovery values.

Finally, counselors who are interested in helping clients determine the meaning and value of using dreams will need to account for the stage of recovery each client is in. Research demonstrates that using dreams differ in function as clients move from early recovery to late recovery (Flowers, L and Zweben, J.,1998). As a general rule, clients in early recovery can expect using dreams to relate literally to their substance abuse problem. Counselors can direct clients to discuss and react to the using dream as if it related specifically to the addictive process.

However, clients in late recovery can expect the using dream to function differently, no longer necessarily relating to actual substance use. The using dream begins to act as an unconscious altering system for clients in the late stage of recovery. These dreams can be viewed as serious warnings that alert the dreamer to major life stressors, difficult emotional experiences, or life transitions independent of substance abuse. Counselors can direct these clients to examine life events that may have triggered a using dream, and help them apply principles of growth comparable to early recovery. In addition to referencing relapse as a metaphor, using dreams in the late stage of recovery can also reference the attitudes and behaviors that made significant change possible in the early stage of recovery. In this regard, the using dream is a call back to the basic principles of recovery, though it’s understood the current need is to apply these principles to problems other than substance use.

 References: Brown, S. (1985). Treating the alcoholic. John Wiley and Sons: New York, New York. Choi, S. (1973). “Dreams as a prognostic factor in alcoholism.” American Journal of Psychiatry, 130: 699-702. Flowers, L and Zweben, J. (1998). The changing role of ‘using’ dreams in addiction recovery.” Journal of Substance Abuse Treatment, Vol. 15 (3). Reid, S. and Simeon, D. (2001). “Progression of Dreams of crack cocaine abusers as a predictor of treatment outcome.” Journal of Mental and Nervous Diseases, Vol. 198 (12).