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Understanding Chronic Relapse & How to Treat It
Table of Contents
Quitting alcohol and drugs is not easy. It takes a community, a strategy, and preferably the guidance of professionals. Even under the best of circumstances, you may relapse one or more times.
Everyone responds to treatment and withdrawal differently, and some people may relapse more often than others. When it happens more frequently than what is considered average, it is referred to as chronic relapse.
Thankfully, all forms of relapse are treatable. But it is important to recognize triggers that could make you relapse.
If you learn to manage those, you can lower your risk of relapse.
TRIGGERS FOR RELAPSE IN MOST PEOPLE
Drug or alcohol relapse means that you use or even misuse a substance after a period of abstaining from it. Because drugs and alcohol can change how the brain’s reward system responds to gratification, some people may be more likely to continuously relapse over the years.
Regular relapse is to be expected, and it does not mean that treatment for drug or alcohol misuse did not work. Relapsing at least one time is common during recovery. In fact, treatment facilities expect relapse, as it is considered part of recovery.
But even relapsing one time can be difficult, especially if you start to feel as if you have personally failed because you did not follow through on your new skills right away. Relapse can be triggered by both positive and negative events.
- Stress is often a reason for relapse because drugs are one of the ways people self-medicate to avoid or forget about things they cannot cope with at the moment.
- Reminders of addiction, such as seeing a bottle or smelling cigarette smoke, can trigger relapse.
- Recovery programs often teach you skills to deal with negative or difficult emotions, but these feelings can cause a relapse.
- Hanging out with friends who use or in places where you used to indulge in your addiction is a common trigger.
- Celebrating special occasions can be difficult as you learn to stay away from substances. Drinking or taking drugs may be seen as more acceptable on such occasions.
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HOW TO RECOGNIZE CHRONIC RELAPSE
On May 2013, Jimmy Long wrote about his struggle with chronic relapse for The Fix. Long mentioned that he was sober for 12 years, but relapsed for another 12 years. He mentioned that he later married a partner who also had drug and alcohol issues.
Throughout his ordeal, Long was arrested, and his partner also dealt with a bevy of consequences. Over time, he learned that his recovery was different, and he often dealt with feelings of guilt.
The Indian Journal of Psychiatry states that addiction is a chronic disease, and relapse is common to the disease. The National Institute on Drug Abuse mentions that relapse often means a person’s treatment must be adjusted.
Relapse means a person must change behaviors that are deep-seated in their psyche.
In February 2012, CBS News covered chronic relapse as it applied to baseball star Josh Hamilton.
An expert interviewed in the report mentioned that substances like alcohol simply wait for the opportunity to strike while you try to recover.
People who are addicted to drugs or alcohol simply crave these substances differently than someone who is not addicted, and that makes drug or alcohol abuse challenging to manage.
CBS News provided one tip that chronic relapsers must recognize that they cannot use willpower alone to combat their addiction. Just as 12-step programs say, the report mentions that surrendering can be much more helpful than the stress of trying to stop your cravings on your own.
RATES OF RELAPSE
In a May 2018 article for the HuffPost, writer Brad Sorte explains that addiction should be viewed like any other chronic disease. Its relapse rates are quite similar to those of other chronic ailments.
In September 2015, the International Journal of High Risk Behaviors & Addiction published a study outlining things that play a role in reducing instances of relapse.
- Relapse rates in treatment centers were up to 30.4 percent.
- Many relapses occurred within the first six months of treatment, though many relapses also occurred after 30 months of treatment.
- Lower levels of relapse were detected in people who were married as opposed to single people.
- Patterns for adolescents were different than for adults.
OVERCOMING & TREATING CHRONIC RELAPSE
One of the challenging things about treating addiction is that it was once thought that full abstinence is the only acceptable outcome of treatment.
About 40 to 60 percent of those in recovery from addiction relapse at some point. This is similar to relapse rates for people with diabetes (30 to 50 percent) and people with asthma (50 to 70 percent). Some experts say it may be time to treat drug addiction the way doctors treat cancer — as a condition where remission may continue to occur.
“Treatment should change so that people can feel comfortable discussing any relapses with their primary care provider or an addiction specialist. As for now, this is what people do if they have another chronic illness, such as diabetes, and they notice that something is wrong.”
The Indian Journal of Psychiatry offers another point of view regarding lapses versus relapses.
Lapses involve using a small amount of a substance a person was once addicted to. A person who is in treatment for alcohol use disorder and has just one drink on one occasion has had a lapse.
Relapses involve returning to prior levels of drug or alcohol use after receiving treatment.
A prolapse occurs when a relapse causes a person to change for the better.
USING RELAPSE PREVENTION AS A TOOL
The Indian Journal of Psychiatry mentions that relapse prevention (RP) uses techniques adapted from cognitive behavioral therapy to help people make changes. It involves identifying high-risk situations, and it has two main goals:
- Harm reduction and the prevention of lapses
- Managing lapses when they occur and preventing relapses
RP looks at recovery from a different perspective. Instead of assuming that everyone will remain abstinent, this point of view understands that it can be difficult to maintain recovery once treatment has ended.
When looking at relapse in this way, RP also assumes that there are reasons why a person would return to alcohol or drugs, such as:
- Losing motivation
- Forgetting skills learned during treatment
- Coming back to environments that caused a person to rely on alcohol or drugs
In September 2015, the Yale Journal of Biology and Medicine published a paper that discussed four main points in relapse prevention:
- Relapse consists of many stages and is a gradual process.
- Recovery has various milestones, and each of these can trigger a relapse.
- Mind-body relaxation and cognitive behavioral therapy are two tools that assist in the prevention of relapse.
- Some basic rules can explain why people relapse.
The Yale Journal of Biology and Medicine also mentions various ways relapse occurs. These include:
This involves denial as people are not thinking about avoiding substances. Instead, they may be focused on their past relapse and harbor emotions that set the stage for a future relapse.
A person battles with their desire to use and abstain from a given substance. A person’s cravings may overpower their ability to continue resisting.
This involves actually using alcohol or drugs, and it relates to opportunity. Often, people are mentally relapsing and cannot control their thoughts, which leads to physical relapse.
Finally, the Yale Journal of Biology and Medicine mentions that people must change their lives if they want to fully leave drugs and alcohol behind. Many people want to return to their old lives but just exclude substances.
This is not possible, as having the same variables in your life can cause you to relapse again. It is important that you are honest with yourself, commit to changing your life, and ask for help no matter how many times you lapse. This can prevent relapses in the future and allow for treatment adjustments that sustain recovery.
Sources
(September 2015) Relapse Prevention and the Five Rules of Recovery. Yale Journal of Biology and Medicine from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553654/
(July 2018) Media Guide: The Science of Drug Use and Addiction: The Basics. National Institute on Drug Abuse from https://www.drugabuse.gov/publications/media-guide/science-drug-use-addiction-basics
(May 2013) Being a Chronic Relapser: The Husband’s Story. The Fix from https://www.thefix.com/content/12-years-drunk-after-12-years-sober2034?page=all
(February 2018) Relapse prevention. Indian Journal of Psychiatry from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844157/
(April 2018) Addiction Relapse Happens, It Is Not A Sign Of Failure. The Huffington Post from https://www.huffpost.com/entry/addiction-relapse-happens-it-is-not-a-sign-of-failure_n_5a204affe4b0a8581e6900b9
(October 2012) Why Relapse Isn’t a Sign of Failure. Psychology Today from https://www.psychologytoday.com/us/blog/where-science-meets-the-steps/201210/why-relapse-isnt-sign-failure
(June 2018) Top 5 Triggers of Relapse and How to Avoid Them. Verywell Mind from https://www.verywellmind.com/why-did-i-relapse-21900
(September 2018) Relapse After Addiction Recovery. Verywell Mind from https://www.verywellmind.com/what-is-relapse-22106
(February 2012) The hazards facing a chronic relapser. CBS News from https://www.cbsnews.com/news/the-hazards-facing-a-chronic-relapser
(September 2015) Survival Analysis of Drug Abuse Relapse in Addiction Treatment Centers. International Journal of High Risk Behaviors & Addiction from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4609495/