Concerns of Substance Abuse Relapse
Addiction is a chronic disease. While countless individuals who suffer from addiction recover, there is always a risk of relapse back to the addictive behavior. Relapse occurs when the individual returns to an addictive substance or behavior after a period of sobriety. Typically, if people relapse, they return to the same substance or behavior to which they were addicted before becoming sober; however, there are instances in which people can recover from one addiction, but turn to another substance or behavior after a period of sobriety.
There are two basic terms used in medical treatment of addiction: a lapse is the first time a person uses a drug, or engages in an addictive behavior, after detoxing. A relapse is the inability to stay sober after undergoing treatment for the addiction; it is essentially a series of lapses close together over time.
Relapse and addiction are both treatable issues, so it is important not to give up, and to keep working to maintain sobriety.
Why Relapse Happens
Relapse occurs because addiction is a chronic illness, which means there is no cure for it. While this can sound frightening, addiction can be managed successfully for life. Addiction is not a personal failure or weakness, but a disease. As medical researchers begin to understand more about this illness, they develop better medications and therapies to manage the disease. Relapse is often simply part of the process of recovery.
Risk of relapse depends on the substance or behavior to which the individual was addicted. For example, people who suffer from addiction to opioid medications have an 85 percent chance of relapsing in the first year of sobriety. People suffering from alcohol use disorder relapse 30-70 percentof the time, depending on specific personal factors and triggers.
Individuals who struggle with addiction often feel driven to stimulate the risk/reward centers in the brain. If a person recovering from an addiction enters a stressful situation, or suffers a psychological trigger, the individual may relapse into drug use to balance the stress with a feeling of satisfaction, reward, or happiness. In some cases, when individuals relapse, they can feel so depressed or anxious because they used again that they re-enter a cycle of abuse or addiction to self-medicate.
Some medical research suggests that there are different triggers for relapse in adults and youth with addiction disorders. For adults recovering from addiction, triggers primarily include anger or frustration; social pressure at family, work, or school functions; or interpersonal conflict with family, a spouse, or friends. For young people, however, both direct and indirect social pressure tend to lead more often to relapse than other situations. Adults tend to enter a negative emotional state just prior to relapse, while youth tend to enter a positive emotional state prior to relapse.
People with schizophrenia, bipolar disorder, antisocial personality disorder, or other psychological disorders are more prone to self-medicating than other individuals. This means that this population has a higher incidence of substance abuse, addictive behaviors, dual diagnoses, and relapse. Additionally, individuals with past trauma, particularly childhood trauma, are more likely to experience relapse than other populations. Individuals who have a history of abuse are 2-3 times more likely to suffer from an addiction than the general population, and they are also more likely to relapse due to emotional or psychological triggers.
False Beliefs about Relapse
There are many myths about relapse, and it is important to understand why these myths are false in order to deal with a relapse, or a potential relapse. Myths about relapse include:
- Relapse occurs suddenly. This is wrong because a lapse or relapse typically occurs due to the emotional discomfort of being sober and having to face emotional stress or triggers. Oftentimes, the buildup to a relapse can take place over weeks or even months.
- Sobriety equals recovery. this is incorrect, because detoxing from all substances does not mean habits formed around substance abuse have changed. It is important for individuals to become aware of their potential triggers, develop healthy lifestyle habits, and address the issues that led to the substance abuse in the first place. Detox does not constitute addiction treatment on its own; comprehensive therapy must address all these issues.
- When people stop going to therapy or peer support meetings, they will relapse. More often, individuals have already relapsed and then decide to stop seeking help. Some people are strong in their recovery and may scale back on therapy sessions and 12-Step meeting attendance; they simply have a firm footing in recovery. It doesn’t mean that relapse is on the horizon.
- Willpower and self-discipline are all it takes to avoid relapse. This is a mistaken belief that is harmful to people in recovery. Addiction isn’t a matter of willpower; it is a disease.
- People who relapse are hopeless. Because addiction is a chronic illness, relapse is sometimes an aspect of living with that illness. Just like it is important for people with cancer to get medical help if their cancer comes out of remission, it is important for people who relapse to get professional help when they suffer a relapse.
One of the most pervasive myths about relapse is that it means treatment failed. This is completely untrue, but the myth is so pervasive that it becomes psychologically damaging to many people who want to seek treatment to overcome their addiction. Relapse doesn’t indicate treatment failure; it simply needs treatment might need to be tweaked to address the issues that led to relapse.
Statistically, around half of all individuals who undergo treatment for addiction relapse, while between 70 and 90 percent at least lapse once during their first year after treatment. Because addiction is a chronic illness, it is important to continue to seek treatment and work toward improved overall wellness.
Returning to Treatment
For individuals struggling with addiction, relapse means a return to some level of treatment. This is true for any other chronic illness too. Individuals with hypertension or diabetes, for example, would not ignore symptoms of a return of their disease, but would seek out appropriate medical treatment. It is important to think of addiction in terms of chronic illness, rather than in terms of personal failure. Treatment is a way of controlling new disease symptoms, and not a punishment for failing to remain sober.
Aftercare’s Role in Preventing Relapse
Aftercare is an important maintenance step for individuals in recovery. Aftercare can help to prevent relapse, or manage relapse before it becomes physically damaging. This form of treatment is a set of strategic, clinical interventions that help individuals in recovery maintain their footing in recovery.
There are three strategic phases of aftercare. These are:
- Early recovery: The first three months after treatment is the most vulnerable time for individuals recovering from addiction. This phase in aftercare programs is called early recovery or abstinence, because it is important for individuals at this stage to abstain from any addictive substances or behaviors. Clients will receive help from therapists and/or support groups to maintain sobriety, manage cravings, and deal with emotional reactions like anxiety and depression. It is also important at this stage to prevent people from dropping out of treatment because they feel “good.” This can lead to relapse without social support.
- Middle recovery: After three months but within the first year of addiction treatment, the individual will work on developing positive lifestyle changes that they can use on a long-term basis. They will learn to identify triggers and manage emotional responses to them. It is important to focus on personal strengths and the individual’s ability to overcome challenges, because this can help the person develop positive self-esteem.
- Advanced recovery: This phase begins 1-2 years after initial treatment. There is continued focus on developing new coping mechanisms and overcoming cravings, along with identifying areas for psychological growth in the individual.
These stages offer consistent levels of support to help individuals maintain their forward momentum, even if they relapse. Without help from therapists, medical professionals, friends, and family, individuals would likely decline after their first lapse, due to the cultural stigma around relapse.
Avoiding and Managing Relapse
In some cases, relapse is unavoidable, but aftercare is the best way to prevent relapse and treat it when it occurs. Although a return to inpatient treatment may not be necessary, some form of care is generally needed following relapse. Consulting a therapist and physician can give the individual input on the best method of treatment after a relapse.
When a person is in addiction recovery treatment, it is important to discuss any fears or anxiety around relapse during therapy. This can encourage the person to begin working on an aftercare plan that can help to prevent relapse and also teach the person how to react in the event relapse occurs.