Drug Relapse and Chronic Relapse – is Recovery Possible?

Denial is an ever-present partner with addiction.

Yes recovery is possible, In fact Relapse is not part of recovery. Relapse is a symptom of ineffective treatment programs. Statistically 75%-90% of all alcoholics or addicts will relapse within the first year of release from traditional treatment programs. The short term 28 day inpatient model or outpatient programs have in the past demonstrated these failure rates.

Addicts and alcoholics usually do work the programs they are taught and do give their best efforts. Unfortunately many addicts fail. You hear from the professionals “he didn’t work the program” or “he’s not ready, he hasn’t hit his bottom”. In fact the program has failed the addict and their family.

Drug Relapse is a heartbreaking event for a family it can in fact be the breaking point. All too often a drug relapse is where the family takes a hard line and tells the addict to “do it on their own” or “we can’t help you anymore”. This is the time families are needed most. There are other treatment options such as programs that have higher success rates or that offer “peace of mind” guarantees to families. This is the time for long term effective care that will treat the biophysical drug cravings and the underlying emotional pain, the root of the addiction.

Typically a 3-5 month residential program with 4-6 months of follow-up aftercare is the recommended treatment method, for most hard-core addictions.

Never Give Up!

Addiction and alcoholism are tricky afflictions. The addict has most likely deeply hurt the family. Lying, cheating, stealing, job loss, violence, even criminal behaviors are all symptoms of the addictive behavior. If these were thesymptoms of cancer would you give up? Of course not, you would try other treatments. You would go to the end of the earth to find something to save your loved one’s life. If you have a chronic relapse victim in your life you are in the same position as a terminal cancer patient’s family if not effectively treated. The addict/alcoholic will die or end up in prison. Unfortunately addiction is viewed all too often in the light of a lack of will power or the addict just wants to get high and doesn’t care about his family. This could not be farther from the truth. Never giving up should not to be confused with enabling on the part of the family. The enabling behavior is destructive and must be stopped immediately upon identifying the active addict or alcoholic. The family must provide treatment options only. For the addict unwilling to get treatment professional intervention is recommended.

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Question:
Is drug relapse common among alcoholics and other drug addicts?
Answer:
Yes, unfortunately. We have a society that promotes the heavy use of alcohol and turns its back when someone relapses. That’s because they treat addiction as moral weakness, not as a chronic medical problem. A recovering patient of mine left his appointment yesterday and before he got home, he counted 70 places beckoning him to drink in a 10-block radius, including liquor stores, bars and grocery stores with their beer ads. Then when he got home and turned on the television, he saw beer commercials and story lines filled with references to alcohol. Environmental cues like these often trigger relapse. When you’re an alcoholic or other drug addict, your biochemistry goes haywire too. Especially your liver, which metabolizes whatever drug you’re addicted to. Hypoglycemia is common among active alcoholics, but instead of burning sugar they’re burning alcohol.

People in recovery need to understand that their body’s craving for sugar often gets mixed up with their craving for alcohol. They need to find a substitute for alcohol to help them deal with the biological cravings caused by their fluctuating blood sugar. That’s why there’s always lots of candy around in AA [Alcoholics Anonymous] meetings. I advise my patients to use a hypoglycemic diet with six meals a day to avoid wide swings of their blood sugar. In addition to a good healthy diet, I emphasize B complex vitamins. Thiamine, in particular, helps prevent delirium and tremors in alcoholics. Also L glutamine, an amino acid [available in health food stores]. It has a unique function in the brain and is said to offer a natural way to help the body fight off cravings. Exercise also is very important in preventing relapse. I recommend that my patients develop a regular exercise routine, even if it’s only “power walking” on a daily basis. During a good workout, the brain releases endorphins that create a “natural high,” one that is certainly less potent than what they’re used to, but a mood elevator nevertheless.

Question:
Is drug relapse more common with some drugs than others?
Answer:
Relapse among alcoholics may be more common simply because there are more alcoholics and because alcohol is so readily available as a social lubricant. The recovering alcoholic in particular faces enormous social pressure to drink. Think about it. When you go to a party, more often than not, you’ll be offered a drink before anything else. When you’re socializing with friends or co-workers, bars are common places to meet. But even if you go to a restaurant, the first question out of the waiter’s mouth is “What would you like to drink?”. Most people don’t recognize how difficult we make it for recovering alcoholics to stay sober. If you know someone in recovery, try to be sensitive to what is, for them, a constant struggle. That’s why I have plenty of soft drinks available whenever I entertain. Some addicts say that the craving for cocaine is more powerful than that for other drugs. Tell that to an alcoholic in the early stages of recovery! A craving is a craving. What’s important to keep in mind is that all addictive drugs have an effect on brain chemistry and liver function. Brain chemistry presents the biggest challenge to recovery because we don’t fully understand the kinds of neurological changes long-term drug use causes. The liver, after all, can regenerate if the patient stops using and eats well.

Of course alcoholics need to remember that just because their liver function has returned to normal, it doesn’t mean they can drink again. I find it’s easier to use an analogy to explain this to my recovering patients than to go into the complicated medical reasons. I tell them that before they started drinking their liver was like a cucumber. Then alcohol turned it into a pickle. And we all know that pickles can’t become cucumbers again.

Question:
What causes drug relapse?
Answer:
Addiction is what we call a “biopsychosocial” disease, which means that biology, psychology and a person’s social environment all contribute to its development. Each one of these factors plays a role in relapse, which makes recovery more difficult for addicts than for patients suffering from other treatable medical conditions. The battle has only just begun once a patient completes detoxification. He or she may need to begin seeing an alcoholism or addictions counselor, a therapist or a psychiatrist who can help them deal with the psychosocial problems that may have contributed to their drinking or drug use. Depression is especially common among alcoholics, particularly women. Regular attendance at self-help groups like AA is important. AA will help alcoholics understand the scope of their disease and prevent them from becoming bitter and angry, or what are known as “dry drunks.”

For recovery to be successful, people need to make major changes in their lives. I urge my patients to develop a plan of action to avoid relapse. It’s a good idea for them to make a list of dangerous situations and how to deal with them. If they’re invited to a wedding, let’s say, they may want to plan to leave early. Or they may want to make sure in advance that a non-alcoholic beverage will be available at their table if they’re going to be called upon to make a toast.

Patients need to examine their drinking or drugging lives carefully to decide what situations may have stimulated them to use. Maybe they’ll find that every time they went to visit their mother they got into an argument and started to drink. If that’s the case, it’s probably not such a good idea for them to visit their mother in early sobriety or until they’ve worked with a therapist through the issues that cause these arguments.

Like they say in AA, stay away from or avoid the people, places and things that are going to remind you of drinking.

Question:
Are some alcoholics and other drug addicts at higher risk for relapse?
Answer:
Addicts without a strong support system are at the highest risk. Let’s face it, if you’re homeless, jobless or without a loving family, the deck is definitely stacked against you. Therefore, it’s best to get patients into treatment before they lose everything.

The first year of sobriety is particularly tough because people have to give their bodies time to get healthy after dependence on a drug that has caused real physiological changes, including cognitive impairment. It takes the body a long time to rid itself of a drug’s aftereffects on the brain and the nervous system. Recovery is hard work; at a minimum it requires proper nutrition, exercise, medical follow-up, counseling and regular attendance at an appropriate self-help program.

Question:
Are there any danger signs associated with drug relapse?
Answer:
When an alcoholic or addict says he or she doesn’t need to go to any more self-help meetings you can be sure that there’s trouble ahead. It may mean “I don’t want to go to AA because I don’t consider myself an alcoholic. And I believe that I can drink again moderately.” The same goes for abandoning their diet or exercise routine or deciding to stop taking prescribed medications such as Antabuse on their own.

Boredom and loneliness are other big concerns. Using takes up a lot of an addict’s time. In the initial stages of recovery, they need to fill this lost time with frequent attendance at self-help groups that are filled with people who are going through exactly what they’re going through.

Question:
Is there anything a recovering person can do if they feel that a drug relapse is imminent?
Answer:
Obviously, staying away from negative influences and finding support is critical. Addicts have to replace their drug habits, with new, healthy habits. Participation in a self help group and a good relationship with a sponsor are the best defenses for a recovering person to confront the self-pity, complacency and dishonesty that often precede relapse.

AA has a very simple acronym, HALT. It means avoid getting hungry, angry, lonely or tired. Each of these areas is critical in recovery. When alcoholics get the urge to drink, they should eat something. Exercise. Get proper rest. Go to a meeting or call their sponsor. That way they can talk to someone else, particularly if they’re upset or angry.
People need to be patient about alcoholism and other drug addiction. It takes time to recover. These illnesses are not something you get over in a couple of days.

Question:
What can the family and friends of an addicted person do to help prevent a drug relapse?
Answer:
Understanding that addiction is a disease is key. Try your hardest not to be moralistic or punitive in dealing with an addict. Instead of making threats or getting angry, express your concern. Say “I’m afraid you’re getting sick again” and urge them to go to a meeting and help them talk through their problems. But don’t allow yourself to be manipulated either; offer to go to an open meeting of a self-help group with them.

My patients are full of guilt, shame and resentment about their alcoholism or addiction. These are all stigma-related and they interfere with the ability to recover. But we’re dealing with a medical problem that’s like other chronic diseases. Addicts are people, too, with a right to get well. They need the opportunity to redeem themselves. If you shut them out of your life, they don’t have that opportunity.

Question:
Many alcoholics and other drug addicts in recovery relapse more than once. Does this mean they aren’t as serious about their recovery as other addicts who have maintained their sobriety continuously since first achieving abstinence?
Answer:
Every case is different. Some people don’t have the necessary support systems or they’re facing another major crisis in their lives. As much progress as we’ve made in educating the public about alcoholism and other drug addictions, most people still don’t understand the chronic nature of these conditions. Because of the stigma that still surrounds drinking too much or using other drugs, the public often blames the addict when he or she relapses. This just isn’t the case for patients who suffer from other behavior-related diseases. In fact, a University of Pennsylvania study has shown that addicted patients comply with treatment advice just as often as patients with asthma, hypertension or diabetes do.

We have a responsibility as a society, too. When a public figure in recovery has a drug relapse the public should not become moralistic or punitive. They should realize that the more well-known the person is, the greater the stigma and the harder their fall. We need to be more forgiving and recognize that the people who suffer from the disease of addiction must be treated with compassion, not contempt