Risk of Relapse and Relapse Prevention
The Risk of Relapse
Relapse is the greatest danger for anyone who has entered recovery from addiction. Thoughts of a return to substance abuse can occur many times during early recovery. No matter how many times the individual has battled successfully against this temptation, they only have to give in once to end up back where they started. This is what makes a relapse such a threat and it never really goes away.
Once the individual has returned to their previous addictive behavior there is no guarantee that they will ever get another opportunity to quit. This resumption of substance abuse can not only be a disastrous event for the individual but also for their friends and family. It is vital that everything possible is done to prevent this from occurring. A lot of time in rehab and aftercare services will be focused on relapse prevention. It is generally accepted that relapse is most likely to occur in the first 90 days of recovery, but the risk remains high for the first 5 years.
The Causes of Relapse
When an individual enters recovery there is usually a sense of relief. Those who lived with the addict may have suffered for years but now the nightmare is finally over. The person who has escaped addiction will experience the benefits as they put their life back together and rebuild relationships. Things seem to be going well but then it all falls apart. The addict is once again abusing alcohol or drugs and those around them don’t understand what went wrong. In many instances the addict themselves can find it hard to explain their actions.
Understanding the causes of relapse has been the focus of a lot of research. The hope is that by identifying these causes there will be things that can be done to prevent it. The most common reason why people return to their addiction is that they have failed to adjust to life in sobriety. There is also agreement that those without some type of support network are the most likely to find adjustment to sobriety difficult.
There are usually signs that the individual is about to relapse. If these symptoms can be observed and acted upon it will mean that disaster can be averted. Relapse prevention involves identifying the triggers and process of relapse. There is always the opportunity to prevent a slide back into addiction right up to the moment that the individual picks up a drink or drug. Over half the people who enter addiction treatment will return to their former destructive behavior within 12 months. Relapse prevention can help reduce this number.
The Relapse Process
The relapse process is an attempt by addiction theorists to explain what happens when and addict returns to former addiction. The process describes a series of steps that lead back to a resumption substance abuse. It is possible for the addict to turn back at any of these steps and there is no inevitable progression to relapse. The steps to relapse identified by Gorski in the relapse process are:
* Becoming stuck happens because an individual loses the motivation to change. Life in sobriety is full of challenges and if they are not faced no more progress can be made.
* Denying the problem may offer temporary relief but this will only work in the short term. Recovery becomes less satisfying because the individual is stuck and not doing anything to resolve the problem.
* Turning to negative habits is the next step in the relapse process. This may involve any type of compulsion that provides an escape from dealing with problems. The most common behaviors to turn to are comfort eating, overworking, excessive exercise, or inappropriate sexual behavior.
* A trigger event occurs and this causes all the pent up frustrations to be released. This event can be something relatively minor but the individual overreacts.
* Emotions take over and now it is hard to think straight. It is now harder to make good choices because the intellect is impaired. These feelings make life a bit unbearable.
* The inner turmoil creates problems externally. It is now more noticeable to those around the addict that something is wrong.
* There is now a feeling of loss of control as the individual is unable to escape the problems they have been trying so hard to ignore.
* Addictive thinking is attractive at this stage because it seems to offer an escape from the current problems. This will involve romancing the drink or drug and associating them with the good times.
* A return to alcohol or drug use now feels like a natural step. The addict may promise themselves that they will be more sensible this time and control their consumption.
* Loss of control will usually occur right after a return to addiction.
A number of different triggers have been identified as possible reasons for why people might return to addiction. 12 Step members are reminded of these triggers by the acronym HALT. These letters stand for hunger, anger, loneliness, and tiredness. These four mental states are viewed as increasing the risk of relapse and so need to be avoided. There have also been other relapse triggers identified and these include:
* Expectations that are too high
* Lack of patience occurs because the individual wants everything in their life fixed right away
* Feelings of Self-Pity In AA they talk about, ‘poor me, poor me, pour me a drink’
* Over confidence
* Abusing other substances The person in recovery may turn to new drugs with the justification that they weren’t addicted to these
* Feelings of frustration because life isn’t meeting expectations
* Expectations of other people that are too high
* Complacency can occur when the individual feels they can ease up on their efforts in recovery
* Depression can occur for a number of reasons; it could be that the individual had this condition all along but had previously being self-medicating with drugs or alcohol
Relapse and Dual Diagnosis
A dual diagnosis is when the individual has another mental health condition as well as their substance abuse or dependency difficulties. This could include conditions such as depression, bipolar disorder, borderline personality, anxiety disorder, or schizophrenia. This problem may have been the reason why the individual turned to addiction in the first place. The condition could also be as a result of the addiction. There is a risk that those with a dual diagnosis will relapse unless both conditions are treated. There are now treatment options available specifically for those who have a dual diagnosis.
It is believed that many of those with a dual diagnosis are not identified as such. This is due to the fact that the symptoms of dual diagnosis can be mistaken as due to the process of withdrawal and settling into recovery. The individual may feel guilty because others will blame their lack of progress on not working the program correctly or not being willing enough to change. If the dual diagnosis is not identified then it will lead to relapse or an unsatisfactory life in recovery.
Relapse Prevention Strategies
Relapse prevention involves helping the individual plan ahead. This way they will have the necessary tools to deal with any pull back to addiction. By understanding the relapse process they will be able to look out for the warning signs. Knowledge about relapse triggers will mean that they can be on their guard against dangerous emotions, feelings, and situations.
Those clients who go through a treatment facility will spend a lot of time focused on relapse prevention strategies. Once they have returned to their home environment this information can fall into the back of their mind. Aftercare resources such as booster session can be a good way to refresh knowledge about relapse prevention strategies.
A Slip or a Relapse
It can be useful to differentiate a slip from a relapse. A slip occurs when the individual takes a drink or drug but regrets it right away and returns to the recovery path. In this situation the slip can be viewed as a lucky escape from which the person can learn. The slip is a sign that something is not quite right in recovery. If the lessons are learned, recovery can be stronger than before. A relapse is when there is a full return to addictive behavior. It can last days, weeks, months, or years. Many people who relapse will never enter recovery again.
Dealing with Relapse
When an addict relapses or slips there can be a sense of failure. These feelings can further push the addict into their addiction. Their self efficacy will be low and they may feel that recovery just isn’t going to work for them. While this type of thinking is common, it is also lethal. It is vital that the addict returns to sobriety as soon as possible.
It often takes more than one attempt to achieve lasting recovery. The important thing is to not delay after a relapse. The longer the individual remains addicted, the more of life will be lost and the more risk there is of reaching a point of no return.