In addiction, a relapse is when someone who has been abstinent from alcohol or drugs for a period of time begins using again. It is considered a relapse whether a person starts using regularly or uses one time. For instance, if someone quit drinking for several months and then had one drink, that would be a relapse. In this article, we will cover: -What causes a relapse? -How common are relapses? -Overcoming shame -Relapse dangers (OD) -What is Revolving Door Syndrome? -Relapse prevention -Next steps
What Causes a Relapse?
Once you have completed a treatment plan, you may think you don’t need any further help. However, addiction isn’t curable; recovery from addiction is an ongoing process that requires continuous care. People who don’t have continued support or a long-term recovery plan may be at risk for a relapse. Additionally, once you leave the structured environment of a treatment center, you may be unprepared to handle environmental triggers. These triggers may include feelings of stress, sadness, anger, or other difficult emotions that can arise in everyday life. Things that remind you of your drinking or using days may also be a trigger. This can include communication with friends or family who use substances, bars or other establishments where you used to drink or use, feelings that you might have previously navigated by drinking or using. The brain is an association machine; if you enter a physical or emotional environment that reminds you of the substance, it can cause intense cravings.
How Common Are Relapses?
Relapses are a common part of recovery—they are often considered part of the process. According to the National Institute on Drug Abuse, 40-60% of people who have undergone treatment for substance use disorders relapse. Addiction alters many areas of the brain, making you more likely to feel out of sorts or even sick without the substance. Some parts of the brain affected by substance use are:
The basal ganglia
The basal ganglia are a region of the brain sometimes referred to as its “reward circuit.” These areas are responsible for helping you learn based on rewards like interpersonal connection, food, sex, and other pleasurable activities. As substance use increases, this region responds by reducing its sensitivity to dopamine, making it harder for you to feel high. This creates a cycle where you use more and more of the substance in order to get the same high. As excessive substance use takes over this part of the brain that normally controls the ability to feel satisfied from healthier activities, you will start to feel less pleasure from things like social interaction, eating, and other natural rewards.
The extended amygdala
The extended amygdala helps regulate feelings like anxiety and unease. It becomes more and more sensitive with excessive substance use. Often, people will continue to abuse substances just to get temporary relief from these difficult feelings, rather than to get high.
The prefrontal cortex
The prefrontal cortex is involved in solving problems, making decisions, and maintaining impulse control. Substance abuse alters the balance between this circuit and the above two systems, making it more likely for you to act on impulses. These brain changes make sticking to sobriety difficult, especially if you don’t have a plan for maintaining your recovery.
People may feel ashamed that they have relapsed. This may even lead to feelings of hopelessness about ever being successful in recovery, causing someone to be resigned to their addiction or to drink or use even more. Relapse is not a personal failure or a failure of will. It is important to remember the above-mentioned facts; there are very real brain changes and environmental triggers that contribute to relapse. If you relapse, it means you are not in denial about your addiction and you have tried to get sober. It is helpful to see it as a step in your recovery process, not the end.
Relapse Dangers (OD)
While it is important to break the stigma and shame surrounding relapses, it is also important to take them seriously. If you are abstinent from certain substances for a period of time and then try to use the same amount as you did before, this can be deadly. This is because your body’s tolerance has dropped. Overdosing on opioids is particularly dangerous, because opioids can depress the central nervous system, causing a person’s breathing to slow or in some cases even stop.
What is Revolving Door Syndrome?
You may know (or have been) a person who is in and out of rehab. This is sometimes referred to as Revolving Door Syndrome—when a person chronically relapses and re-enters treatment. This can be mentally and emotionally draining; with each relapse, the person may feel extra pressure, with the looming threat of another relapse ever-present. If you are stuck in a cycle of chronic relapsing, you may not be receiving the kind of care you need. For one, many treatment facilities last about a month. As addiction is a complex disease that affects multiple aspects of your life, you might consider finding a longer treatment program. A 90-day stay would allow you more time to go deeper after initial detox, providing you the time to address the roots of your addiction and avoid relapse. It would also be helpful to find a treatment center that specializes in aftercare and relapse prevention. Another reason people relapse is that they may have an undiagnosed co-occurring disorder. In this case, it is important to find a treatment center that specializes in dual diagnoses and that can provide you with a recovery plan to treat both.
There are many steps you can take to make relapse less likely. As relapses can happen at any stage in recovery, these are always helpful tools to keep in mind–even if you don’t feel at risk of relapsing.
Be aware of your triggers
As mentioned earlier, triggers can come from within you (feelings) or they can be environmental (people, places, or things). If you know your triggers, you can try to avoid them. However, if you can’t avoid them, it is still very helpful to know what they are. This way, if you are in a situation involving your triggers, you can easily identify why your cravings are coming up; you will know that once you leave the situation, those feelings will likely subside.This may take the power away from them.
After a period of abstinence, you might romanticize your drinking or using days. With some distance, it can be easy to forget the many negatives of active addiction. It can be helpful to think about what consequences will occur when you drink or use. This is sometimes called “playing the tape through.” If you play the tape through to the end, you will see that drinking or using doesn’t sound very appealing after all.
Make a list of emergency contacts
Having a list on-hand of healthy people to turn to is very helpful in any stage of recovery. These may be people in recovery themselves, or simply people who have supported you in sobriety. These friends or family members can remind you why you don’t want to pick up a drink or use drugs. They can also offer love and care while you work through difficult feelings.
If you are at risk of relapse, sober community housing is another helpful option. Your home life may be full of environmental triggers; community housing takes you out of that environment and surrounds you with a sober support system. In a community housing program, you will be around others who are committed to the same thing as you: recovery.
I’m Afraid I Will Relapse. What Are Some Next Steps?
At Amatus Recovery Centers across the country, we offer treatment for co-occurring disorders, aftercare planning, community housing, help with finding sober support groups, and other tools to support your long-term recovery. Whether you have relapsed once, have relapsed multiple times, or haven’t relapsed but are afraid you will, it is not the end. There is help–and, most importantly, there is hope.