Preventing Relapse

Drug addiction is a complex but treatable brain disease. It is characterized by compulsive drug craving, seeking, and use that persists even in the face of severe adverse consequences. For many people, drug addiction becomes chronic, with relapses possible even after long periods of abstinence. In fact, relapse to drug abuse occurs at rates similar to those for other well-characterized, chronic medical illnesses such as diabetes, hypertension, and asthma. As a chronic, recurring illness, addiction may require repeated treatments to increase the intervals between relapses and diminish their intensity, until abstinence is achieved. Through treatment tailored to individual needs, people with drug addiction can recover and lead productive lives.

The addict has a chronic, pervasive, progressive disease. In early recovery he/she CANNOT behave in the same way that other members of society do. In other words, the addict must identify and avoid those triggers that would lead to relapse. Although different people respond to different approaches, the research is clear on which approaches have the best success rates. The standard recommendations include:

1.    Recovery must be the number one priority in the recovering addict’s life.

2.    90 meetings in 90 days. The addict must substitute recovery for drug use and drug-seeking. Once addicted, the mere anticipation of getting high will trigger a marked dopamine response in the addict and/or alcoholic. Likewise early recovery from addictions is often hampered by the lack of dopamine d2 receptors that take many months to return to baseline functioning. The lack of sufficient d2 receptors is a primary reason that many drug addicts and alcoholics fail at abstinence during the first 90 days of their recovery.

Following the first three months of sobriety, the addict should attend no fewer than 3 meetings per week. After the first two years, the recovering addict can reduce this amount to one meeting per week if everything else is going well.

3.    Sponsorship. Daily calls and weekly meetings with a caring recovering addict are vital. Checking in with a caring person improves accountability.

4.    Step work. Homework assignments must be done and given to the sponsor on a weekly basis.

5.    Total and complete abstinence from ALL mind-altering drugs. This includes alcohol, even though it’s legal.

6.    A detailed and careful history to determine which triggers lead to relapse.

7.    Change of “playground, playmates and playthings.” The addict must avoid using friends, as well as places and activities that re-activate cravings.

8.    Abstinence from other addictions—cigarettes, pornography, etc.

9.    Relationships must be put on hold until the addict is on a firm footing with his or her sobriety. Although friendships are important, new relationships with the opposite sex should be avoided during the first two years of recovery.

10.    Study of inspirational literature. The people who have the greatest success rates are those who find a Higher Power and are able to “let go and let God.”

As I mentioned earlier, different people respond to different approaches. The above list has been standard for many years with minor variations for different people. With further research, even more variations are possible.  Those of us in the recovery field always hope for more research that can help the addict that still suffers.

Does Relapse Mean Treatment Failure?

Relapses are Painful

"Relapse should not be viewed as a failure; it is part of a learning process that eventually leads to recovery," says Susan Merle Gordon, Ph.D. Even though relapses are painful for the addict and hurtful to the addict’s loved ones, a relapse can often help the addict discover where his efforts have been incomplete. Unfortunately, many people are under the mistaken impression that a relapse with drugs means that the program failed. Let’s examine why this belief is mistaken.

Addiction is a Disease

Although addiction starts with a choice to use drugs or alcohol, it can progress to disease proportions in many people. Addiction is a pervasive, progressive, chronic disease. Pervasive means that it affects every area of the person’s life. Progressive means that it gets worse and worse over time. Chronic diseases are diseases of long duration and generally slow progression. Examples of chronic diseases and conditions are heart disease, obesity, osteoporosis, diabetes, asthma, arthritis, Alzheimer’s Disease and other dementias, and cancer.

Three Dog Nightmare

Chuck Negron, vocalist and founding member of the band, Three Dog Night, is a good example of how the disease of addiction can progress. Although he’s an extreme case, his struggle with addiction is illuminating. Remaining in the grip of addiction for nearly 20 years, Negron wasted away to 126 pounds and went through 36 rehab programs. In his book Three Dog Nightmare, he details his ordeal with this painful disease. He sold his gold records to subsidize his $2000 a day heroin habit. He talks about overdoses, car crashes, gun play, suicide attempts, and contracting hepatitis C. Did he hit bottom? Many, many times. And yet the disease of addiction ruled his life for decades. He has been clean and sober since his 37th rehab. That doesn’t mean that the 36 prior rehabilitation programs were a waste of time and money. He clearly states that he learned important things from each one of the recovery programs that he went through. And he slowly made important life changes that helped him on his journey to sobriety. And as he matured, he began to look at his selfish, self-destructive path with more clarity. Each one of those 37 rehabs played a part in his recovery and helped him to look at himself.

How Many People Relapse?

Terence Gorski, internationally-famous lecturer and author on relapse and addiction states: “Relapse is not necessarily a sign of treatment failure. Between one half and two-thirds of all patients treated will relapse, but at least one half of all relapsers will find long-term recovery. The belief that relapse means that treatment failed ignores the fact that, for many patients, recovery involves a series of relapse episodes. Each relapse, if properly dealt with in treatment, can become the learning experience which makes the patient less likely to relapse in the future."
A woman that I’ve seen off and on in psychotherapy for the past 10 years has made great progress in addressing her chronic disease. Her path in addressing obesity has been typical of so many recovering addicts. She gained and lost well over 1000 pounds. She would diet, then binge. She felt sabotaged by every social event, birthday party, special holiday and Sunday dinner. She “cheated” on her diet (a relapse in recovery terms) many times and gave up on herself many times. As we slowly worked on her self esteem and identity, she made baby steps in changing her habits. Today she is at her ideal weight and has been at that weight for three years. Has she completely conquered obesity? Heavens, no. She’ll need to be vigilant about her habits the rest of her life. But she is absolutely not sabotaging her health the way that she was ten years ago. “Cheating” today involves eating a 1 inch square of birthday cake (rather than the whole cake ten years ago).

This Disease is Complex

The disease of addiction is extremely complex. Overcoming it involves learning new skills, new habits, allowing the brain (and organs) time to recover, making new friends, and learning how to make self-enhancing choices. This takes time—often years. Parents who take teenage drug abuse seriously and get help for their teens are helping this process to begin.  Any stepping stone along the path to recovery is helpful.

Recovery is a Process

And this process takes time. Recovery is not an event. That's why you don't hear people in AA say, "I'm a recovered alcoholic. They say, "I'm an alcoholic." They don't know what tomorrow will bring. None of us want them to relapse, but it's not uncommon if it does happen.

The ultimate purpose of treatment is to keep the patient alive until the addiction is finally controlled. Addiction too often results in suicide or accidental death by overdose, experimentation, or contaminated products.

Copyright © 2009 Kathie Keeler, All Rights Reserved. No part of this article  may be reproduced, stored, or transferred by any print or electronic means without the express written consent of the copyright owner.