Vital Information About Relapse Prevention in Detoxification
November 22, 2018
You know what they say about insanity? Repeating the same thing and expecting different outcomes. An addict, whether if alcohol or drugs can wake up one morning with the desire to abstain their use in totality in pursuit of better outcomes, but then immediately change their minds when faced with the immediate opportunity to use again. Even though that their dependence is hurting them and more so those around them, they will put more value on drinking or using drugs over the value of abstinence. The damage occurs after repeated indulgences, which is why the self-control failure plays a role in the undesirable way of life, behavior, addiction, and relapse. Similarly, a recovering alcoholic may take certain drugs to help them stay sober, and they very well know that if they drink they are bound to get violently ill, but when the temptation of drinking overpowers their desire for abstinence, they will drink anyway. They would rather get sick.
Addiction is a brain disease, not a mind disease and a non-alcoholic or non-drug user may think, “why can’t an addict just quit?” “why do they keep relapsing?” the questions are never-ending. Well, the brain is a physical entity that has many responsibilities for a host of human functions, whereas the mind is an abstract reality and the output of the brain’s function. The brain at the center of all human activity and regulates the body’s basic functions even shaping someone’s behavior. Alcohol and drug abuse change important brain areas that are necessary for life-sustaining functions such as pleasure, moods, problem-solving, decision making, self-control and many other impulses that make us human.
The pleasure and euphoria an addict gets from using involves surges of chemical signaling compounds such as endorphins (the body’s natural opioids), and dopamine which are associated with reward has more to do with getting an addict to reinforce alcohol or drug and repeat pleasurable activities and experiences. Large surges of these chemical compound dopamine, in particular, have been shown to trigger uncontrollable cravings and consequently, teach an addict to seek drugs or alcohol at the expense of their relationship with other, healthier goals and activities. It becomes like a learned reflex that can last a very long time, which is people who have been sober for many years can experience cravings even if alcohol or drug of choice is not available, because the brain remembers simple triggers like smells, returning to an old neighborhood or house where they “used.”
There is no known cure for dependence on alcohol or drugs, a fact that has even baffled modern science and to them, what causes a person to pound down alcohol uncontrollably or use illicit drugs to the point of death still remains largely a mysterious physical disease coupled with a psychological illness. The mind of an addict is a strong one, but also fragile in different ways than that any non-user can fathom, which is why topics like addiction and substance abuse seem far removed the same way mood or mental disorders such as depression, anxiety, ADHD, Bipolar, etc. can seem remote to those who don’t experience them. The truth is addiction is an insidious disease that can creep up on anyone, in fact, did you know that the word addiction is derived from the Latin words meaning “handed over?’
Most compulsive behavioral indulgences such as gambling, sex, shopping, food, coffee, sugar, smoking, etc. affect the same brain pathways, which tells you that most people have a dependence on other things beyond illegal drugs or alcohol. That of addiction and substance dependence is characterized by compulsive seeking and use, despite harmful consequences. When you think about it, addiction is more really the pursuit of pleasure and the avoidance of displeasure because most of those who are deep in addiction use drugs or alcohol as a means to avoid dealing with one thing or another, from lack of employment, unhappy relationships, lack finances, failing in school, and much more. So, do you have an addiction? A “yes” answer to the following questions would suggest that you do and should consult further help and guidance:
- Do you use drugs or alcohol or engage in the behavior more often than in the past?
- Do you have withdrawal symptoms when you are not drinking or using your substance of choice?
- Do you often lie to those around you about your drug or alcohol use or cover the extent of your behavior?
The physiological aspect of addiction differs from person to person, which makes it a concept that is not entirely understood, for example, a study suggested that men and women struggling with addictions respond differently to stress, drug and alcohol cues, and so their ideal treatment options might differ. So, besides the physical factors, environment, and internal factors, what makes one person seem more vulnerable to addiction and relapse than others because no one wakes up one day wanting to become an addict or even label themselves as such?
There is no one-size-fits all approach to overcoming addiction, but the first, and often the hardest step is to admit that there’s a problem. Seeking help from a qualified medical professional, who can offer medication (if necessary) combined with behavioral therapy is the second step. Treatment may also include detoxification, medication to combat withdrawal, and individual and group therapy for different lengths of time.
3 Main Causes of Relapse
While there is no definite cure for substance use and alcohol disorders, research on the science of addiction shows that there are research-based methods that help those in need to counteract addiction’s disruptive effects on their brain and behavior and regain control of their lives in recovery. It’s not uncommon or unheard-of for someone to “fall off the wagon,” return to alcohol or drug use or relapse after an attempt to stop due to the chronic nature of addiction. Recovery can seem pretty straightforward to individuals who have never experienced addiction, and they have the notion that an addict should, you know, simply admit they have a problem, go to rehab, complete treatment, get sober and stay sober for the rest of their lives. Those who have a first-hand experience with addiction know that this belief can’t be further from the truth or that easy.
It is estimated that between 70-90% of all patients who complete an addiction treatment experience at least one mild to moderate relapse before they achieve full sobriety. These numbers may seem high and although many doctors suggest that relapse is a natural part of recovering from addiction, this message being communicated can also do more harm than good. Addiction relapse is a common occurrence because not all patients in a rehabilitation center “really” want to get sober in fact, most addicts seek treatment just to comply with certain rules or conditions (often with dire consequences) that have been set upon them. Ultimately, it is up to the individual to assume the responsibility for managing his or her own care and comply with their ongoing treatment and recovery process. The following are the main reasons why most people relapse after treatment:
- Being around people, places, or things connected to the addiction
Most addicts who relapse nearly always do so in response to drug or alcohol cues or triggers. For example, a drug addict may start using again after seeing certain drug paraphernalia or even passing through places where they used to score drugs. An alcoholic may feel the urge to drink if he or she is around friends or family members who they used to drink with and are still engaging in the addictive behavior. These triggers are the problematic cues that can be overwhelming and strong enough to lead to cravings and a desire to obtain a user’s substance of abuse. We as human beings are wired to respond to certain triggers through a process known as conditioning and the “high” that addicts get from using produce a strong, rewarding sensation, which they can experience when the trigger is present.
Being around people, places and thing triggers has been shown to present real risk and even detrimental outcomes for people in recovery. It is important for individuals in rehab for their addiction to identify their PPT triggers before completing their initial treatment. While it can be a stressful process of coming up with a list of PPT’s because it ultimately challenges someone to look deeply into their addiction, but once an individual has fully identified and understood these triggers it can help them minimize the risk of relapsing, and they can comfortably move on to the next step of coping with their triggers
Without the right support system, stress is probably the number one cause even a motivator of relapse. Think about it this way; even for someone who is neither an addict or alcoholic, but is going through extreme stress, chances are they will reach for a beer or a glass of wine to relax. While stress is a natural part of life (probably builds character) most addicts often suffer from poor coping skills, which can make it quite challenging for them to deal with any situation that is unfamiliar, intense, unpredictable, or high-pressure. Examples of life situations that can seem too overwhelming for a recovering addict may include
- A dysfunctional marriage or relationship(s)
- Unresolved childhood trauma
- Lack of employment
- Lack of stable housing
- Interpersonal conflicts
- Mental illness
- Loss of loved ones
- Poor nutrition
- Prescribed medication for relapse prevention and much more
Most addicts use drugs or alcohol as a crutch and the more they use they eventually develop tolerance, and they need to use more to feel the same effect, which is “usually” to numb their pain. You can imagine how extremely uncomfortable it would be for them to no longer have their substance of choice as a safety net and are forced to deal with all the emotions they’ve bottled up for years face to face. This explains the importance of skills development in addiction treatment such as understanding how stress affects the brain and learning stress prevention and tolerance, after all, stress in a normal and inevitable part of life that everyone goes through.
Lack of Support
Addiction is to healthy relationships what cancer is to the body and even for addicts with the most supportive families and friends, substance, and alcohol use disorder can be the impossible barrier to overcome because like a malignant tumor, addiction can spread, weaken and destroy loving relationships. Family therapy is an integral part of most recovery programs because the entire family, including close friends, are impacted by a substance abuse disorder or addiction. It changes the entire dynamics of relationships, where family members find themselves in unnatural and often unfair position. For example, a child may step into the role of caregiver if a parent is an addict, a sibling could take on responsibilities for a sister or brother and much more. Additionally, there is bound to be emotional issues such as extreme anger, despondency, paranoia, anxiety, depression and even grief in a home where addiction is at play. The outward consequences of substance abuse and addiction can also impact a family’s finances either from funding a user’s addiction or paying for their treatment.
It helps the healing process when family members of an addict are involved in their treatment from the onset so that they can receive educational information and assistance from health professionals in order to help them go through a process of acceptance and apply their strengths to not only prevent relapses but to also help them take the necessary steps toward a healthier family dynamic and repaired relationships.
Stages of Relapse
According to author Terence. T Gorski, there are three stages of relapse based on the foundations of the Alcoholics Anonymous (AA) and Narcotics Anonymous support groups. These stages include:
- Emotional Relapse – this is the earliest stage where even though an addict isn’t using drugs or drinking, he or she is experiencing negative emotions and acting in self-destructive ways that can jeopardize their continued recovery. During this stage, an addict will either distance themselves from others or become anxious, angry, defensive, or uncompromising. He or she may also display some dysfunctional behaviors such as not eating or sleeping, refusing to ask for help, or finding excuses not to attend meetings or outpatient counseling sessions. In order to avoid an emotional relapse, it’s important for an addict to ask for help, master their moods and emotions and do all can to care for their physical and emotional well-being.
- Mental Relapse – this is the destructive thoughts stage, and while an addict hasn’t used drugs or drunk yet, he or she will have constant thoughts about using and even go a step further and put themselves in risky situations such as being with users or being in places where their substance is used. While it’s normal to think about using again, intervention at this stage is critical because an addict’s cravings can intensify and trigger them to use again. Surviving a mental relapse can be achieved by seeking a healthy distraction from your “destructive thought.” It can mean going to a meeting, changing your scenery or even sharing your feelings with a loved one or your sponsor.
- Physical Relapse – it doesn’t take long or much for a mental relapse to develop into an actual relapse. It is during a physical relapse that an addict acquires their substance of choice and uses it again. This stage can be as a result of both emotional and mental relapse, where emotions have gotten the best of you and through unmanned triggers. A physical relapse can also be as a result of unresolved psychological disorders such as anxiety, depression, PTSD or co-occurring mental illnesses that do not magically resolve just because someone has stopped drinking or using drugs. Additionally, many people in early recovery fall into the trap of being overconfident enough to think they have a handle on their situation. Therefore, they cut off their support system and may stop seeing their therapist or attending 12-step meetings.
Addiction is not something that goes away just because someone has completed treatment. In fact, it is after treatment that an addict is more vulnerable because they are more or less like a baby whose taking its very first steps. Recovering from a chronic drug or alcohol addiction can place enormous pressure on a person enough for them to succumb to cravings, stress, and negative emotions, and go back to their substance of choice. When someone goes through recovery, everything feels uncomfortable even chaotic because they are seeing the world through new eyes. There is nothing as constant as change and to a recovering addict, change is uncomfortable because it forces them to reevaluate their life before and after addiction and they can only do so by pushing away the discomfort and building back their self-worth amidst the chaos.
Addiction strips away the very fabric of what makes you human and being in recovery can be confusing because you don’t know who you are or even what to do without drugs or alcohol. Boredom, restlessness or loneliness were probably your main reasons for “using” in the past, but they are the same emotions that you are bound to experience when sober. The key is your willingness to dig deep and take the necessary steps that will help you cultivate healthy relationships, find a job that you’ll enjoy, pick up new hobbies, even return to the activities you enjoyed before you were addicted. At this point learn to develop some general coping strategies because by now, you already know your triggers. For example:
- Master a few cues that will warn you when your sobriety is about to be compromised
- Learn new relaxation techniques such as meditation to help you unwind when things get too stressful
- Learn how to manage any negative emotions, irrational thoughts, self-defeating behaviors, or unmanageable feelings
- Avoid being in the proximity of your triggers by using the avoidance therapy
- Don’t try to restore your old life because it can difficult, depressing, and may put you back in the same place that led you to become addicted
- Do not substitute a new addiction of compulsion for your old one
- Develop a structured schedule
- Become more accountable to yourself and the people in your support system
- Spend time with sober friends
- Be in constant communication with your sponsor
- Eat a balanced meal
- Get enough sleep and exercise
You are not alone if your greatest fear is that you will not be able to maintain your sobriety, but it is the fear of failing that often drives people to seek help or avoid treatment in the first place. Knowing that you always have a choice to do what’s right for your sobriety should become your driving force. Addiction is a tricky disease and instead of obsessing about your fear of relapsing, why not help others who are in the same predicament. You don’t need to be a licensed addiction counselor or psychiatrist to share your story with someone who is struggling with addiction, you may just be their saving grace. Additionally, turning your efforts to help others to overcome similar problems can also help you maintain your sobriety and avoid relapse in the long run. It also gives you an opportunity to gain new perspective as you progress through your own journey, but don’t forget to prioritize your recovery and well-being.
Remember to always touch base with your doctor or addiction counselor not only to assess how you are doing but to also revise your relapse plan. Always keep in mind that in as much as you want to help others, you too are not entirely out of the woodwork, and you still need all the help and support you can garner. The secret of preventing relapse is:
- To get professional help
- Having a relapse prevention plan
- Recognizing the warning signs and stages of a relapse (Emotional, mental and physical)
- Learning how to control triggers