Relapse: What You Need to Know and Do
If you care about someone who was once addicted to drugs or alcohol, you probably already worry about relapse. What will happen if he or she suffers a relapse after rehab?
As a non-addicted person, it might also be extremely difficult for you to understand why people relapse on drugs or alcohol after finally getting sober. After all, your loved one spent so much time and effort beating addiction — why do people relapse on drugs or alcohol after working so hard at getting sober?
The answers are complex. Addiction is a chronic disease that causes serious, long-lasting physiological, emotional and behavioral problems. It is also a condition that usually requires a commitment to lifelong care. Even the most successful-looking people who were once addicted and have been sober for years can return to chronic substance abuse.
If someone you love is in danger of returning to an addictive lifestyle, here is what you need to know, including how to handle a drug or alcohol relapse.
Lapse vs. Relapse
The first thing you need to do is figure out if the person you care about has truly suffered a relapse. It is very common for people who are recovering from a dependency on alcohol or drugs to “slip” but not return completely to addictive behavior.
For example, imagine you went to a party last night with someone who has made a commitment to sobriety. He has been doing well, but at the party one thing led to another. When you saw him later in the night, he was drinking and doing drugs. Today, when you called to check in on him, he apologized for using. He said he made a mistake, has already called his sponsor and has recommitted to sobriety.
Although we know how upsetting it is to see someone who has committed to sobriety start using drugs or alcohol again, one night of using does not mean his or her addictive behaviors have returned. It does mean that you will have to be vigilant, however.
You are likely able to tell when your loved one is using now that you already know what to look for — lies and denials despite obvious evidence, unexplained changes in mood, changes in sleeping and eating patterns, forgetting or ignoring responsibilities. If you observe these behaviors, your loved one needs to get help now.
The Statistics of Relapse
You’re not the first person to have concerns about a loved one backsliding into addiction. More than half of those with a substance abuse problem return to addictive behavior — over 60% overall. Some drugs are more likely to cause relapse than others. People who use heroin, for example, suffer the highest risk of relapse at 91% — of those who relapsed, 59% started using again within one week.
The NIH also found that certain factors — such as age, amount of use, method of administration and participation in aftercare — affected the likelihood of relapse. The most significant finding from the NIH is that people who get help and participate in aftercare are more likely to stay sober. Similarly, alcohol addiction is also likely to result in relapse, although rates vary significantly depending on the definition of remission as well as whether or not the individual gets help.
Why Relapse Happens: Biology
Addiction has been a problem faced by cultures around the world for thousands of years, from alcohol and marijuana to cocaine and morphine. Although all drugs and alcohol produce a “high” sensation, they each affect the brain in different ways.
Central nervous system depressants slow down functions such as breathing and heart rate while inducing relaxation and reducing anxiety. Central nervous system stimulants increase breathing and heart rate, often producing manic or excitable feelings. All substances — whether they stimulate or depress — negatively affect brain function.
The nerves and chemicals in the brain help us learn, make decisions and feel pleasure. When we do something that feels good, the brain “records the experience”, according to Harvard University.
This powerful chemical reaction causes us to repeat actions that help us feel good. Nature intended our brains to use this chemical pathway to assure survival and reproduction; unfortunately, it was not prepared for us to use drugs or alcohol to circumvent the reward-takes-effort process. According to Harvard,
In nature, rewards usually come only with effort and after a delay. Addictive drugs provide a shortcut. Each in its own way sets in motion a biological process that results in flooding the [brain] with dopamine. The pleasure is not serving survival or reproduction, and evolution has not provided our brains with an easy way to withstand the onslaught. In a person who becomes addicted through repeated use of a drug, overwhelmed receptor cells call for a shutdown…The brain is losing its access to other, less immediate and powerful sources of reward…they want the drug even when it no longer gives pleasure.
In simpler terms, the brain of your loved one has learned that only drugs or alcohol can provide pleasurable — or even normal — feelings. The “addictive drug shortcut” also causes a more intense high than what healthy, responsible behaviors produce. At the same time this happens, your loved one’s brain becomes chemically unable to create happy feelings by engaging in positive behaviors that provide reward through slower means.
It can take years for the brain to relearn that non-addictive habits feel good. Although we don’t completely understand the science of cravings, we do know that this is — in part — why people relapse.
Why People Relapse: Behavior, Mental Health and Stress
If staying sober were as simple as waiting for the brain to heal itself, then there would be far fewer people addicted to drugs and alcohol. In addition to the chemical changes that take place in the brain concerning reward and learning, conditioned behaviors are also likely to trigger a relapse.
Your loved one likely associates certain people, places or events with using drugs or alcohol. That is why behavioral therapies — such as cognitive behavioral therapy — train the user to identify and avoid triggers that lead to using. These triggers might include seeing people who still use, going to a favorite bar or restaurant, or major life events such as a wedding or funeral.
There are other factors as well. If your loved one suffers from a mental health disorder such as depression, PTSD, ADD or ADHD, panic disorder or anxiety, he or she is more likely to use drugs or alcohol — especially if this condition has never been diagnosed or treated.
Suffering from addiction and a mental health disorder at the same time is known as dual diagnosis. In these cases, treating the addiction requires treating the disorder. Without addressing the underlying mental health issue, your loved one is much more likely to relapse.
Your loved one might also be suffering under the weight of intense stress. Stress is a leading cause of relapse. For example, if the person you care about recently lost a loved one, went through a divorce or is having career problems, the urge to use might become overwhelming.
If you know your loved one is having a rough time, reach out. Not only can a well-timed phone call provide much-needed relief, you can also use the opportunity to encourage your loved one to get counseling or therapy.
Behavioral and psychiatric therapies — such as cognitive behavioral and psychotherapy — can help your loved one relieve stress. They can also shed light on why he or she started using. These therapies may not speed the biological healing process in the brain, but they can help your loved one deal with the underlying feelings that lead to using.
Your loved one may be trying to self-treat an overwhelming sense of sadness or anxiety with the instant false relief provided by alcohol or drugs. Behavioral and psychiatric therapies can teach your loved one how to recognize and address internal stressors with healthier actions and greater confidence.
Behavior and psychiatric therapies are also two of the most important ways your loved one can sustain sobriety after rehab ends. According to the National Institutes of Health and multiple additional sources, your loved one is much more likely to stay sober permanently if he or she makes counseling and/or therapy an ongoing part of life. That may mean attending meetings or private counseling sessions for years after having the last drink or dose of drugs. Since the temptation to relapse peaks at roughly six months beyond the first days of sobriety — and not the first few days, no matter how intense the urge to use may feel — counseling can be an invaluable weapon in the fight against relapse.
Why People Relapse: Genetics and Environment
Perhaps the two greatest predictors of whether or not you will ever become addicted to drugs or alcohol are genetics and environment. People who have a close family member — such as a parent, grandparent or sibling — with addiction are 50 percent more likely to develop a problem themselves.
Keep in mind that this is not inevitable. Your loved one may have many family members addicted to drugs or alcohol, or he or she may be the only one.
Compounding the genetics issue is environment. The more time your loved one spends around alcohol or drugs — or with people who use alcohol or drugs — the more likely he or she is to start using again. That is why the behavioral counseling component is so important. During behavioral counseling, your loved one can develop the skills to avoid the people, places and activities that lead to using and relapse.
What to Do After a Relapse Happens
When Alcoholics Anonymous formed in the early 20th century, almost no one thought that addiction had a biological component. If you had a loved one who couldn’t stop drinking or doing drugs, it was because that person was morally weak or lacked the willpower to say no. Addiction was a disease that families hid from their friends.
Alcoholics Anonymous was the first time anyone ever tried to help a struggling addict. It is still the most successful recovery philosophy in the world. Today, treatment centers combine the principles of AA with the hard science we’ve learned over the past generation.
If relapse has occurred, do not give up hope. Instead, get your loved one into treatment.
Most people who have been addicted to alcohol or drugs wind up relapsing at some point. Recovery is a lifelong journey; unfortunately, relapse seems to be one stop on the road to abstinence for many individuals.
Stay in touch frequently. Research clearly demonstrates that struggling addicts are more likely to get and stay sober permanently when they have the ongoing support of caring family and friends.
Your first move should be to talk to your loved one when he or she is sober and alone — or at least calm. Never approach someone who is clearly under the influence of drugs or alcohol to talk about sobriety.
Tell your loved one that you know he or she is using again. Ask him or her to consider going back to rehab. Avoid using judgmental language and statements that blame your loved one for the problem — even if you believe, deep down, that it’s his or her fault. Addicts are extremely sensitive people. When your loved one goes back into treatment, you’ll have plenty of time to address your own feelings of sadness, disappointment and anger.
If your loved one is unwilling to listen, it might be time to plan an intervention. An intervention can be an extremely powerful tool.
During an intervention, you and others who share your concerns will confront your loved one about relapse. You’ll express your wishes that he or she get help, too. The most effective interventions take place under the guidance of a professional interventionist who is prepared to escort the struggling addict to rehab. A professional interventionist will also plan and lead the meeting.
Poorly planned interventions can spiral out of control quickly, because the participants can be angry, anxious, emotional and stubborn. Having a professional interventionist there keeps the meeting moving forward and in control.
If you work with an interventionist to get your loved one back into rehab, you should plan that he or she will leave for residential care as soon as the meeting ends. If the meeting doesn’t go as planned, try not to despair. Many former addicts point to a “failed” intervention as a big reason they decided to get sober later.
Finally, if your efforts to convince your loved one to get help have not yet succeeded, don’t hesitate to join a counseling group or get therapy yourself. Living with an addicted person is extremely difficult.
It’s important to manage your own life and deal with your own feelings. So many of us let our lives revolve around the addicted person that we forget what it’s like to feel carefree and happy. Don’t let your loved one’s addiction ruin two lives — get help for yourself, too.
We Understand Because We’ve Been There, Too
We know just how hard it is to stay sober, and we are here to help. You can quit using, and you can start now — all you have to do is ask for help. We see miracles every day at 12 Keys Rehab. We may be able to help you — even if you’ve tried rehab before.
Learn more about what to do when someone relapses. Call 12 Keys Rehab now and let us help you find a permanent path to freedom, starting today.