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Recovery doesn't happen overnight; it is a long, hard process. Sometimes an individual's old ways win out for a time, and there is a relapse. It can be a single slip or one that lasts for a longer period. There are warning signs preceding a relapse. The person in recovery may get too cocky or complacent. Many recovering addicts who relapse say, "I was using the drug before I realized what I was doing."
Some of the danger signs of impending relapse are impatience/fatigue, anger/depression, guilt/shame, anxiety/worry/self-pity and lack of discipline.
When the individual is dissatisfied with the way his life is going, he gets impatient. "I'm not doing drugs, and it doesn't make any difference." Not getting enough rest can be a warning sign. Exhaustion lowers a person's resistance. The substance abuser may unconsciously be looking for an excuse to use drugs. When a person is tired, he is not thinking clearly and may not make the best decisions.
Anger can lead to a relapse. Everyone experiences angry feelings from time to time. They may be caused by irritation about the paper boy not delivering the paper or annoyance at not being able to find a clerk to wait on you. People can usually handle these little aggravations. Others seem to be angry all the time. You can feel it when you are in their presence. This is misguided energy. Chronically angry people blame others for their problems. It is anger they could not express in childhood, and they are still carrying it around. Anger that is not expressed is turned inward and results in depression. Both these types of anger need to be explored, preferably with a therapist, and be resolved.
Anger is a normal human feeling, and in recovery the person is told to acknowledge the feeling and then release it. Expressing anger is a new skill that the sober person is learning. He never dealt with his anger when he was a substance abuser. Now he has the tools to come to terms with it.
Depression is treatable and should not be ignored. The substance abuser knows all about pain and loneliness. He has to keep in mind that it is a human condition and one he can recover from. When there is a relapse he must get back on the path and continue the program.
"Whatever's begun in anger ends in shame." (Poor Richard's Almanac, Benjamin Franklin)
Substance abuse creates guilt and shame in a person. Guilt comes when he knows he is doing something wrong, and shame is the feeling he has about it. A recovering person must acknowledge and accept all the wrong actions he has committed but must not take on the shame. Shame inhibits a person's recovery.
When a person is in a relationship and feels guilty, there is an inequality. A healthy relationship must be equal. The guilty partner must be honest with himself and others. Trust is the basis of all healthy relationships. Guilt is a complicated feeling, and the hardest kind of guilt to resolve is that created by many incidents over a period of time. Guilt needs to be resolved immediately.
Too many people worry about things that never happen. This is their imagination working overtime. It is a fact, the world today gives everyone many things to be anxious about. There is an old Chinese adage: "You cannot stop the birds of the air from flying over your head, but you need not let them rest in your hair."
Don't waste energy on things over which you have no control. Worry is a state of mind before the event happens. Worry brings stress. Stress is the mind and body's response to the demands placed on it by the experience of change and is not completely unavoidable. To be alive is to be under stress. It is possible to change the response to stress.
A person can avoid, alter or adapt to any situation. Give himself permission not to be perfect. A personal stress management plan is part of any treatment program.
Are there steps that can be taken early in the recovery process to minimize the chances of a relapse? Yes, there are. The person should be able to identify the events, people and situations that will trigger a relapse.
Relapse can be avoided if the substance abuser is absolutely convinced that he can never take the drug of choice again. An overpowering compulsion comes over the substance abuser at die time of relapse. One way to prevent a relapse is to educate and counsel the significant people in his life about what to do in this situation. They should have an emergency plan that can go into effect immediately. Experience has proved that having such a plan shortens the relapse period and allows the substance abuser to return quickly to the recovery period. A family conference is recommended to trace the steps that led to the relapse and to go over how to manage these high-risk situations.
John read only disapproval and rejection on his family's faces. He thought he was worthless. Full of self-pity, John is already making excuses to relapse. He needs much love and understanding from his family.
Anatole France wrote, "Change is a terrifying notion. All changes, even the most longed for, have their melancholy, for what we leave behind us is a part of ourselves; we must die to one life before we can enter into another."
When the substance abuser is an adolescent, the family needs support to help them deal with the guilt, shame and embarrassment about having an addicted child. Sometimes they don't feel they are understood or listened to. They are filled with anger, frustration and disbelief.
The structure of the treatment program has to meet the needs of all, or it won't be successful. The transition from a drug-centered lifestyle to a sober one is harder for adolescents. They believe they can control drugs, and because of their inexperience, they do not understand that drugs are the cause of their problems. So the focus of recovery is to convince them that they are addicted.
Contact with friends who are users and discontinuing the aftercare program can cause an adolescent's relapse.
Substituting alcohol for a drug is a contributing factor to relapse. It is important for treatment programs to emphasize the danger of this happening. Clearly, the younger person requires a more aggressive treatment and after care program due to his greater risk of relapse. Overall, women have a significantly lower relapse rate than men. The older the person, the better the prognosis.
Social workers will need to recognize and deal with the reality of relapse. High rates of relapse are demoralizing to the staff of a treatment program. It can have a negative effect on the staff's motivation and treatment efforts.
There is a movement to research relapse prevention. Greater flexibility of services can reduce the problem of long waiting lists for outpatient counseling. One suggestion is that inpatient programs could designate several beds for short-term stabilization in cases where a person is in a relapse process or has had a brief relapse.
An inner calm is attainable. The more you accept yourself and your uniqueness, the better you can function in a world you create for yourself. Stay near healthy people with whom you are comfortable and can share your fears. If you criticize yourself and continue to self-punish, the more likely the relapse is to continue. A relapse tells the person that there is more work to be done. That's all! Anyone can make a mistake, it's part of living. Accept your shortcomings and continue working the program.
Develop trust and intimacy in the family circle. The family needs to feel valued and important to the substance abuser. Mutual respect will support the goal of recovery.
Relapse can occur any time after a period of sobriety. Change is hard for anyone.
Warning signs of relapse:
The substance abuser has to be committed to abstinence and understand the fact that he can never take drugs again.
Tips for staying sober:
Treatment of relapse:
Taking charge:
Don't waste energy on things you have no control over. Guilt robs a person of his energy.
A trigger stimulus is anything that a person associates with a substance use. It can be a favorite place, a certain time of the day or a sports activity.