What is Relapse?
Dear Dr. Steve:I am so angry with my son I
can hardly see straight. Three inpatient treatment programs and $45,000.00 later, he is
still drinking and drugging. I’ve been to all of the lectures. I’ve sat in on
more family sessions than I care to remember. I’ve been told countless times by very
nice people that my son has a disease, that he’s not to be blamed, and that there are
no guarantees. Anytime I press for hard answers as to why my son walks out of a treatment
program and goes straight to his dealer they just tell me that I have to let go and let
God. That’s all fine and well. But five years after the fact, my son can’t
stay straight for more than six weeks at a time. And then it’s back to the same old
thing—lots of good intentions, followed by lots of empty words, followed by lots of
broken promises, followed by lots of unpaid bills, followed by lots of eviction notices,
followed by some emergency room crisis, followed by my wife and I putting my son back in
rehab, followed by short periods of abstinence, followed by lots of good intentions …
Why can’t my son just quit?
You
deserve an answer to your question. However, I’m afraid that the complexities of the
answer still won’t be enough to lessen the hurt and fear that is overwhelming you but
I’ll try. The factors that contribute to relapse are as many and varied and
interrelated as the strands of metal that are woven together to make a cable wire. In this
column, I’ll address only one aspect of what contributes to relapse. The aspect that
I’m going to address is the unique stressors that confront somebody in their first
year of attempted abstinence. Those stressors are: 1.) protracted withdrawal, 2.) safely
facing the emerging facts and awakening feelings about one’s life, 3.) internalizing
an identity that acknowledges one’s inability to control their drug and alcohol
intake, 4.) mastering a series of life skills that support the newly abstinent
individual’s choice of sobriety.
As you
already know, chemical dependency, whether it is alcoholism or drug addiction is a
primary, chronic, progressive disease that is prone to relapse. Although a recovering
alcoholic and drug addict will always be vulnerable to relapse, people who are in their
first year of abstinence are particularly vulnerable to relapse. There are physical and
psychological reasons that people are especially vulnerable to relapse in their first year
of abstinence. One reason has to do with the phenomena of withdrawal. Although symptoms
from the acute withdrawal from alcohol and drugs manifests themselves for a relatively
short period once an individual has become abstinent, there is another phenomena that an
abstinent individual must contend with. That phenomena is called protracted withdrawal.
The period of time that protracted withdrawal affects an abstinent individual varies from
individual to individual. Some of the variables that affect how long someone is vulnerable
to symptoms of protracted withdrawal are frequency, duration, and types of drugs an
individual used. The reason that protracted withdrawal makes an individual vulnerable to
relapse is because of the physical and emotional effect it has on that individual.
You can
see how protracted withdrawal may make someone vulnerable to relapse. Most people, once
they go through the initial pain of withdrawal believe that they should feel as good as
new. However, if an individual doesn’t feel as good as new, they are vulnerable
to feel disappointed, resentful, and disillusioned. If they don’t take the time to
factor in the phenomena of protracted withdrawal and if they haven’t developed the
necessary skills of abstinence, then they are prone to medicate their discouragement with
drugs and alcohol. Their old way of thinking may kick in and they’ll justify taking a
pill that will finally allow them to sleep or they’ll take a pill to help them feel
re-energized. Or their discouragement will just get the best of them, so they give up
altogether and go back to drinking and drugging.
Besides
protracted withdrawal, there are other stressors that people who are new to abstinence are
particularly vulnerable to. Awakening feelings that were previously medicated can be very
disturbing to the newly abstinent individual. An expanded awareness of what their lives
had become is another stressor that the newly abstinent individual must learn how to deal
with besides drinking and drugging. Until the newly abstinent individual develops
fundamental coping skills to deal with the stressors of their life without the use of
drugs and alcohol, their raw emotions, their fragile psyches, and their reliance on new
untested behaviors as coping mechanisms makes the newly abstinent individual vulnerable to
relapse. These vulnerabilities can be successfully overcome in time through 1.) education
about global relapse risk factors,
2.) identification of personal set-ups for relapse, and 3.) the mastery of alternative
behavioral strategies.
A third
reason people in early abstinence are vulnerable to relapse is because not all people who
attempt to become abstinent intend to remain abstinent. There are those individuals who
are attempting abstinence in order to appease a family member, to save a job, to comply
with the legal system, to comply with some medical dictate that requires abstinence so as
not to inflame or worsen a co-existing medical disorder, and/or to attempt to learn how to
become a controlled drinker. These individuals may experience short periods of abstinence
accompanied by long periods of relapse. Usually, these individuals plan a relapse
once the crisis that precipitated their abstinence has passed.
Relapse
also occurs because the individual is in a relapse mode. There is a saying that relapse
doesn’t occur when you pick up the drink. It started a day ago or a week ago when
some behaviors or attitudes became more prominent in the newly abstinent individual’s
mindset. Examples of this would be: 1.) Failure to fully internalize the belief that an
individual is powerless over alcohol and drugs, 2.) The reemerging belief that the newly
abstinent individual can return to controlled drinking and drugging, 3.) Continuing to
spend time with old drinking and drugging buddies, 4.) Lessening or ceasing altogether
one’s involvement in their 12-Step community, 5.) Failure to develop drug-free
recreational activities, 6.) Returning to old habits that are connected with one’s
prior drinking and drugging.
The fact
that chemical dependency is a primary, chronic, progressive, and prone to relapse disease
does not me that it can’t be managed. Your son is not to be blamed for contracting
his disease, but he is certainly responsible for managing it. The degree to which your son
takes responsibility for managing his disease, will determine how successful he will be in
negotiating the long and winding road of relapse.
Learn
how to prevent and recover from chemical dependency as well as the aftereffects of
chemical dependency on you and your family. Read Dr. Frisch’s, Psy.D. series of
Recovery books—From
Insanity to Serenity.
Pathfinder’s
Checklist
1.) Chemical dependency is a primary, progressive, chronic, potentially fatal disease that
is prone to relapse.
2.) In the first year of abstinence there are specific stressors that makes an individual
particularly vulnerable to relapse.
3.) Protracted withdrawal is a phenomena where the newly abstinent continues to experience
withdrawal symptoms up to a year after becoming abstinent. These symptoms may continue to
negatively impact one’s mood, cognitive functioning, and physical well-being.
4.) The newly abstinent individual must internalize a set of coping skills that will
enable them to remain sober rather than use drugs and alcohol.
5.) Not every person who attempts abstinence does so with the idea that they intend to
remain abstinent over the long haul.
G.B.U.
Steve
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