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It is typical for movies and television to mistakenly characterize rehab as the climax of a person’s substance abuse story; they go there, they get clean, and they live happily ever after. However, in reality, rehab is but a crucial opening salvo of a lifelong battle for sobriety. While the road towards recovery may begin at an alcohol or drug detox recovery center, that path does not become treacherous until a person departs that refuge.
Back in the real world, a newly sober person is once more faced with the stresses, triggers, and temptations that may have caused them to use in the first place, making relapse a distinct possibility. As a parent, sibling, friend, or spouse, it is vital that you are there to support your loved one who will likely struggle to stay clean. Since the chains of addiction to drugs or alcohol can take years to break, it is crucial that you know the common indications of an impending relapse. Further, it is recommended that you strategize how you will react if your loved one does relapse and have a relapse prevention plan in place to get them back to sobriety.
Relapse is Common
For many people who have struggled with substance abuse, their sobriety story is not a linear experience, always trending upwards; rather, it is filled with ups and downs, good days and bad—mistakes, slipups, and unfortunately, relapse. While there are merits to thinking positively and believing in your loved one’s ability to remain sober, it is essential to treat the situation realistically.
A 2013 Yale report titled, New Findings on Biological Factors Predicting Addiction Relapse Vulnerability studied 800+ patients over a year-long period following their discharge and found that a significant majority of users relapsed within a year of rehab. According to the paper, “It has long been known that addictive disorders are chronic and relapsing in nature. Recent estimates from clinical treatment studies suggest that more than two-thirds of individuals relapse within weeks to months of initiating treatment. For 1-year outcomes across alcohol, nicotine, weight, and illicit drug abuse, studies show that more than 85% of individuals relapse and return to drug use within 1 year of treatment.”
No one wants their loved one to mess up and return to their old ways. While it is understandable to feel a sense of hopelessness by the likelihood of relapse, it is critical that you remain optimistic and recalibrate your views towards recovery. Relapse is a common feature in many people’s recovery stories, but it is not the end of their narratives. In fact, a large portion of those in recovery will relapse multiple times before they ever reach freedom. With this in mind, it is crucial that you discuss this possibility with your loved one and plan for the worst.
Planning for Relapse
Having a relapse prevention plan for a loved one in recovery does not mean relapse is an inevitability, it’s simply preparing for all scenarios. Any great coach or military strategist will have an A, B, and C plan. If you want to be a source of accountability and strength for your loved one to be clean and sober, then you need to have honest discussions with your friend about what you both will do if and when a relapse occurs.
Both of you should have answers to the following questions:
- If I feel tempted to use who should I call?
- If I feel tempted to use what will I do to get myself out of that situation?
- What are my triggers? How can I avoid them?
- What are my stressors? How can I avoid them?
- Who are the people who I can’t be around?
- What are the places or situations that make me feel like using?
- If a relapse happens, who will I call?
- If a relapse occurs is another stint in rehab or detox necessary?
- Who is the medical expert who can meet with you in order to strategize?
- Are there substance abuse groups that you can go to help process this slip-up?
Knowing how to help a friend after a relapse or preventing them from getting to that point will be necessary during the recovery process. Just talking through the prospect of a relapse can help imprint this conversation on their mind, acting as an anchor or a lifeline when they might feel a strong temptation to break their sobriety. As the person providing support and encouragement, this gives you the groundwork to act right away and not give in to despair. Further, it provides you with insight into your loved one’s condition, helping you understand their particular weaknesses so that you can keep a vigilant eye out and take action when necessary.
The Stages of Relapse
At its essence, relapse happens when your loved one breaks their sobriety of drugs or alcohol. This, however, is a simplistic view of relapse. Realistically, relapse is not a single event, but a process that builds like a volcano. Relapse can begin weeks if not months prior to the physical act of taking a drug or drink. In reality, there are three stages of relapse:
- Emotional relapse
- Mental relapse
- Physical relapse.
The physical act of returning to drugs or alcohol is the culmination of all three phases. How much damage a relapse causes depends on the individual, but it is best that they return to sobriety as soon as possible.
When emotional relapse begins, a person is not actively considering using, but their emotions and behaviors are preparing them for a possible future relapse. Rehab is meant to train them for re-entry, giving them stress management tools and coping skills to help prevent them from turning to drugs or falling for their addiction triggers. Exiting this drug-free sanctuary and returning home can be a challenging experience for your loved one. They will be forced to handle the stresses and triggers of life on their own. They will have to actively choose to not rely on drugs or alcohol to cope. Relapse and the path to recovery is never easy, however with the right support and guidance you or your loved will be able to obtain sobriety.
Signs of emotional relapse that you should keep an eye out for include:
- Avoiding attending meetings
- Bottling up emotions
- Mood swings
- Not seeking help
- Poor eating habits
- Poor sleep habits
- Poor self-care
Many of the indicators of emotional relapse are symptoms of post-acute withdrawal. Keep in mind that denial plays a significant role in this stage, so if you see these signs in your loved one, it is important you say something and intervene immediately. Emotional relapse is the easiest stage to pull back from and to reorient a person back towards sobriety.
It is critical that you are providing support and not causing them more stress. A 2015 study found that there is a “Significant positive relationships between frequency of relapse and tolerance/expectation, negative attitude, and emotional response but the relationship between the frequency of relapse and the emotional intervention was not significant. There were significant negative relationships between frequency of relapse and perceived social support from family, friends, and total social support.” Your job is to build them up and encourage them to focus on self-care, specifically emotional self-care. They should create time for themselves to relax, to have fun, and to enjoy the world without drugs or alcohol.
At some point, the consequences of a protracted lack of self-care and mishandling of emotions lead to the next phase of relapse. This rising tension, agitation, and anxiety continuously builds until they reach a point where they begin daydreaming about using or drinking as a means of escape. When this happens, their sober-self and addicted-self go to war; a part of them wants to use, and a part of them fights those feelings. If left to fester, their mental defenses grow weaker and that voice telling them to stop becomes quieter. What may begin as a daydream can morph into a physical act.
Signs of mental relapse in your loved one may include:
- Acknowledging that they are regularly craving drugs or alcohol
- Fondly reminiscing on the good times they were high or drunk
- Glamorizing their past drug or alcohol use and minimizing the adverse problems
- Going places they once used or drank
- Planning a relapse
- Sneaking around
- Spending time with people they once used or drank with
- Tempting themselves
Brief thoughts about past drug or alcohol use are normal, but fantasizing and fixating on past usage, places, people, or situations is a recipe for disaster. Many previous users get scared when they have occasional cravings and feel guilty that they are doing something wrong. As a result, they bottle these emotions and thoughts. Your job is to love, support, and encourage them to be open about their struggles and not to be embarrassed by apparent weakness. By creating an open dialogue, you can help them release that emotional tension and prevent pressure from building.
Merely thinking about past drug use does not mean that your loved one is failing in their recovery. It is impossible for them to wipe out memories of prior drug use. By normalizing these occasional thoughts and bringing them into the light, you can help your loved one view them objectively and then move on.
Physical relapse is when your loved one turns to drugs or alcohol again. Some medical professionals distinguish it into two categories:
- Lapse – A lapse is an initial dalliance with drugs or alcohol. Some refer to this as a slip-up. It generally refers to a mistake that is addressed and corrected immediately. A slip up is often an unplanned error in judgment from which a person learns and grows, returning immediately to sobriety and recovery.
- Relapse – A relapse is when a person abandons their recovery and fully embraces uninhibited drug use or alcohol abuse. Often, a person makes a lapse in judgment, uses again, feels guilty about that decision, and then gives up on their recovery.
Many lapses are opportunistic. Your loved one sees a chance to use and, thinking they might not be caught, takes it. Once they come down from the high or the drunk, many are filled with self-loathing, guilt, and shame. This is true whether they have been sober for a week or ten years. Because of this, it is vital that they do not give in to self-pity and resign themselves to failure.
In his book, Is There a Rebel in This House? Dr. Edward D. Andrews discusses how a person does not have to allow a slip to turn into a relapse. He states: “It is understandable that people will feel guilty and a bit ashamed of their slip, but feeling this way can be highly dangerous – it also benefits nobody. They may convince themselves that all is lost, and so the only option is to resume their addiction like before. This type of thinking is not only highly destructive but is also completely wrong. A slip can be a turning point in recovery because it indicates that people have been doing something wrong. If these individuals can learn from the incident, it may mean that their recovery will be stronger than ever.”
How to React When A Loved One Relapses
If your loved one does lapse in their sobriety, it is critical that you do not get angry, upset, yell, or blame them. By remaining even-keeled, you can be the difference between a lapse and a relapse. Your job is to support them and encourage them. Your role is to create a dialogue that helps them objectively analyze where things went wrong. Both of you should sit down and answer the following questions:
- What were you feeling in the days or weeks leading up to the lapse?
- Was there a single event or incident that was the turning point
- What could I have done to support you or help you?
- How can we avoid this in the future?
- Did you stop attending meetings?
- How can you focus on your self-care
- What can I do to prevent adding stress?
Once you have discussed these things, it is crucial that, together, you formulate a plan of action. This might require booking one-on-one therapy sessions, encouraging your loved one to attend additional support group sessions, or planning another trip to rehab for the recovering addict.
Remember, relapse in recovering addicts is not the end of the road, but simply a setback. Treat it like this and you will help your loved one keep fighting their battle to remain sober. If your loved one relapsed and is once more physically dependent on drugs or alcohol, an additional trip to rehab may be necessary. Since detox from drugs or alcohol can be uncomfortable and dangerous, it may be wise that your loved one detoxes at an inpatient facility such as Beach House Recovery. If you determine that is necessary, act immediately so that you can help your loved one get back on their road to recovery.
NCBI, “New Findings on Biological Factors Predicting Addiction Relapse Vulnerability.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674771/#R2
NCBI, “The Role of Family Expressed Emotion and Perceived Social Support in Predicting Addiction Relapse.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4393558/
“Is there a Rebel in This House.” Dr. Edward D. Andrews. P.117