Relapse

RELAPSE IS PART OF THE DISEASE

Relapse rates amongst people with the disease of addiction are very high. Statistics vary, but most put the rate of relapse at about 60-80% within the first year following treatment. Longer term treatment tends to lead to longer recovery periods, but relapse is still more often the rule — not the exception. However, relapse does not have to happen (or, as many say, “it is not a requirement”).

Relapse is not unique to the disease of addiction alone. In fact, most other chronic diseases have similar relapse rates. People with hypertension, diabetes, and asthma have to adhere to the proper treatment of these chronic illnesses or they are likely to “relapse” into a period in which they struggle with symptoms and have trouble maintaining proper health. A person with diabetes must eat a proper diet, exercise, check their blood sugar, take medications properly, and practice other healthy behaviors in order to keep their diabetes stabilized. If they do not do these things, they are likely to “relapse” – in other words, they will go through a period of time in which their diabetes is more difficult to manage (and may even lead to hospitalization).

Also, when a person is first diagnosed with a chronic illness, it is very unlikely that they will learn how to treat it properly right away; instead, they are likely to go through a period of trial and error. The same is true for the disease of addiction. Recovery is often a long-term, life-long process requiring repeated treatment attempts.

IF RELAPSE OCCURS

If relapse occurs, it is important for loved ones not to inflict shame on the person; he/she are likely already struggling with a great deal of shame and guilt. The important thing to remember is that relapse does not mean failure. It is important for the person to focus on what the person did right and get help again as soon as possible. If he/she had a period of abstinence, this shows what the person is capable of achieving. Perhaps this period of time can be repeated and lengthened. Sharing the relapse experience with family, friends, 12-step recovery members, and/or an addiction professional, can help the individual to identify what happened and how to prevent relapse in the future. A major focus of treatment is on helping people achieve longer and longer periods of recovery time and shorter periods of actual use. The hope is that eventually the person will learn what not to do through these relapse experiences and begin to build a stronger and stronger recovery program that leads to long-term abstinence in the future.

IT IS ALL ABOUT THE “GO!”

It is important to remember that addiction is a brain disease and that relapse has a biological basis. Click on the following link to read an article about how addiction causes a disruption in the “Stop!” and “Go!” system in the brain:

http://www.hbo.com/addiction/understanding_addiction/112_stop_go_mechanisms.html

TRIGGERS

Triggers are “cues” to the brain – or reminders – that stimulate the brain into thinking that an opportunity to use may be on the horizon. Triggers do not cause the use, but may start the process of craving. See the section “A Drive, Not a Choice” to read more about Pavlov, conditioning, and what happens when a person is triggered. 

WARNING SIGNS THAT RELAPSE MAY BE COMING

Traditional vs. Behavioral Relapse

The traditional definition of relapse is use after a period of not using. However, relapse is about more than just using a substance. Rarely ever does a person just instantly make a decision to use; there tends to be a whole set of thoughts, reactions, and/or behaviors that lead up to that point.  Just as addiction became a way of life for the person, recovery must become a way of life as well. For example, the addicted person’s life revolves around their use; they surround themselves with friends that use, they engage in hobbies during which they can use; they wake up looking for ways to make sure they can continue to use. In recovery, a person must make recovery a part of their life in similar ways. They must surround themselves with people in recovery – or people who are positive influences and who understand their disease. Their daily lives should be recovery-focused in every way. If a person is trying to stay clean and sober, yet they haven’t made the necessary changes in their life such as changing their friends or places where they hang out, then relapse is likely to occur.

Behavioral Relapse is important to consider when a person is trying to stay clean and sober. Behavioral relapse is a return to “addictive” behaviors (thinking, feelings, reactions), causing a person to become dysfunctional in their recovery – meaning, the person returns to engaging in behaviors that are likely to lead to use if they continue the behavior.

Examples of addictive behaviors include:

-Hanging out with friends that use or in places where use has previously occurred.

-Isolation, avoidance of positive friends/support, slacking off on recovery behaviors that have been working (for example, going to meetings, calling a sponsor).

-Reminiscing about use, telling “war stories” about use, glorifying, romanticizing, blaming others, minimizing, cockiness.

-Lying, hiding, keeping secrets, cheating, stealing, manipulating, keeping a consistently negative attitude, wearing a “mask” (hiding their true self or being superficial), living a double life.

-Engaging in other obsessive-compulsive behaviors, or switching from one addiction to another such as: sex, gambling, shopping, food, exercise, workaholism.

COMMON RELAPSE ATTITUDES

SOBRIETY IS BORING
I’LL NEVER DRINK/USE AGAIN
I CAN DO IT MYSELF
I’M NOT AS BAD AS …..
I OWE THIS ONE TO ME
MY PROBLEMS CAN’T BE SOLVED
I WISH I WAS HAPPY
I DON’T CARE
IF NOBODY ELSE CARES, WHY SHOULD I?
THINGS HAVE CHANGED
I CAN SUBSTITUTE
THEY DON’T KNOW WHAT THEY ARE TALKING ABOUT
THERE’S GOT TO BE A BETTER WAY
I CAN’T CHANGE THE WAY I THINK
IF I MOVE, EVERYTHING WILL CHANGE
I LIKE MY OLD FRIENDS
I CAN DO THINGS DIFFERENTLY
NOBODY NEEDS TO KNOW HOW I FEEL
I’M DEPRESSED
I SEE THINGS MY WAY ONLY
I FEEL HOPELESS
I CAN HANDLE IT
IF I HIDE BEHIND EVERYONE ELSE’S PROBLEMS, I WON’T
HAVE TO FACE MY OWN
I CAN’T DO IT
WHY TRY

THE TEN MOST COMMON RELAPSE DANGERS

1. Being in the presence of drugs or alcohol, drug or alcohol users, or places where the person used or bought chemicals.

2. Feelings that are perceived as negative, particularly anger; also sadness, loneliness, guilt, fear, and anxiety.

3. Positive feelings that make a person want to celebrate.

4. Boredom.

5. Getting high on any drug.

6. Physical pain.

7. Listening to war stories and dwelling on getting high.

8. Suddenly having a lot of cash.

9. Using prescription drugs that can get a person high even if used properly.

10. Believing that the person no longer has to worry (complacency). That is, the person is no longer stimulated to crave drugs/alcohol by any of the above situations, or by anything else – and therefore you start to think that it’s safe to use occasionally.

PREVENTING RELAPSE

Relapse can be prevented by identifying potential triggers, avoiding them, and using recovery tools that work. However, even if a person is vigilant about avoiding triggers, there still may be some that are unavoidable or unexpected (such as unpredictable major life events like loss, grief, trauma, painful emotions). The best thing to do is to have a plan of action for what to do when triggers arise.

PLAN FOR PREVENTING RELAPSE

1. Don’t drink or use any mood altering/mind altering chemicals, including over-the-counter substances that contain these chemicals.

2. Find supportive people with whom to surround yourself (who don’t drink or use) and engage in activities, such as journaling, exercise, hobbies or interests that boost your self-esteem. Distraction is key to recovery.

3. Think about the things you want to achieve that you are unlikely to achieve if you drink/use again. Make a list of these goals and carry them with you in case you need to remind yourself of the reasons why you don’t use.

4. Make a list of the consequences that your addiction has cost you. Consider how addiction has impacted your finances, relationships, health, emotional/mental state, social life, spiritual life, legal record, and professional life. Also consider what has NOT happened yet that could happen if you drink/use again. Carry this list with you and read it during difficult moments.

5. Always have a way out of a situation. For example, drive your own car to social gatherings so that you can leave if you need to leave.

6. Consider what might be warning signs of potential relapse for you and come up with specific plans for taking action when these warning signs come up.

7. Think of a particularly devastating incident during your active addiction (for example, sitting in a jail cell and promising yourself that you’d never use again) and write it down/recall it in detail when you are triggered. This helps “the pain outweigh the pleasure” – and that is likely to help you abstain.

8. Get really good at calling your sponsor or supportive people who understand the disease and can talk you through difficult moments.

9. Reward yourself for not using. The reward should be something positive (a massage, a meal out with a friend, buying an item that you’ve been wanting) and something that is not a trigger.

10. Practice HALT (don’t get too Hungry, Angry, Lonely, or Tired).

Here is a printable version of a tool that you can use to create your own personal relapse prevention plan:

Personal Plan to Prevent Relapse

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