The experience of watching helplessly as a loved one relapses is among the most distressing experiences any family can have. Yet, it’s all too common during addictions recovery. When someone is trying to overcome the negative effects of alcohol or drug use in their life, most people tend to view treatment as a short-term scenario. The hope for most people suffering from addiction, and their families, is to overcome drugs or alcohol and get their life back on track as fast as possible. Then they want to be done with addiction forever. These hopes for a quick treatment and permanent resolution of addiction are entirely understandable, but unfortunately, such a definitive outcome applies to only a subset of people with alcohol or drug problems. So, what should you do if you or a loved one has relapsed on alcohol or drugs?
Sometimes multiple treatments are needed for a patient to ensure control of addictive behavior
While rehabilitation is effective for most patients, and professional treatment is the best option for overcoming addiction, the treatment process is not always simple or straightforward with addiction. The truth is that with addictions treatment, sometimes multiple treatments are needed for a patient to ensure control of addictive behavior. Sometimes, patients leave treatment too early and may need to return to treatment so that they can improve on skills or learn skills that they missed in the prior treatment. Other times, addictive behavior returns early in the recovery process, or it turns out someone needed to stay in treatment longer to ensure success. If an addiction was particularly severe, the associated treatment will be longer, and addictions recovery is highly dependent on the addiction profile of the drug used. So, predicting a patient’s relapse potential is a complex issue.
Consequently, when identifying a treatment program it’s extremely important to ensure an addictions treatment program is JCAHO Accredited (Joint Commission on Accreditation of Healthcare Organizations) and is approved for handling Dual Diagnosis cases. These programs are going to be best prepared to address the issue of relapse. When helping patients overcome addiction there is a balance between helping them address immediate needs and providing them with a skill set that will ensure long-term success. Helping someone calm emotional distress in the moment is just as important as helping them prepare for cravings management months or even years down the road. This long-term view of addictions treatment is called “Relapse Prevention,” and it’s one of the most fundamental components of any addictions rehabilitation program. If done well, many patients can potentially avoid or minimize the need for later hospitalizations, or recognize when re-hospitalization is necessary, ensuring long-term success with recovery and rebuilding life. So, if you or someone you love is considering seeking addiction treatment, be certain to get information about any evidence-based relapse prevention programs a treatment center provides!
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Before discussing relapse prevention approaches, I want to take a moment and help readers understand that although addiction causes many short-term problems, often severe problems, addiction is primarily viewed by mental health professionals as akin to a chronic disease. This is because 30-60% of people receiving treatment for addictions have either relapse or recurrence following completion of addictions rehabilitation (Andersson, Wenaas, & Nordfjærn, 2019; Ignaszewski, 2021). A relapse occurs when a patient is improving from drug or alcohol use symptoms but before recovery is complete the patient’s substance use behavior returns. Similarly, a recurrence occurs when a patient has recovered fully from substance use disorder symptoms for a long period but then returns to problematic substance use. Addiction recurrence can occur many years after successful treatment (Sliedrech et al., 2019).
The reasons for a patient relapsing or recovering are many
The reasons for a patient relapsing or recovering are many and different for each patient, however, one thing that most patients share is that substance cravings can occur even years or decades after stopping prior use. Such drugs or alcohol cravings are typically the results of brain changes that occur during substance use, neurological changes that cause the patient to desire drug use even despite all the problems that arise (Wemm & Sinha, 2019). Thus, because of the long-term potential to return to drug use, some researchers have suggested treating addiction like other chronic illnesses, with relapse simply serving as a trigger for renewed intervention (McLellan et al., 2000). It is because of this understanding of the nature of addiction that successful addictions recovery programs integrate relapse prevention programs as a part of recovery.
Factors that Contribute to Addictions Relapse
During the initial phases of rehabilitation from drugs or alcohol, treatment is primarily focused on addressing short-term needs. This includes medical management of withdrawal symptoms, addressing major life problems caused by substance use (e.g., legal, family considerations), and helping patients start to build cravings coping skills. The early stages of treatment are most difficult because of the discomforts of withdrawal and frustrations of coming to terms with having a substance use problem, but things get a little easier in the later parts of hospitalization and rehabilitation.
Upon treatment completion, however, the real challenges for recovering patients begin
Upon treatment completion, however, the real challenges for recovering patients begin. Although most patients leave treatment feeling stronger to manage their lives, new skill sets obtained during treatment, and a patient’s resolve to control addictive behavior, are tested almost immediately. Patients returning to their lives will face many stressors, both old and new, and they will have easier access to alcohol or another chemical substance than was the case when they were in a treatment program. Although some of these stressors will fade and disappear with time, some of them can remain for many years, potentially catching people off guard. Some of the factors that contribute to addiction relapse include: failing to address co-occurring psychiatric disorders like depression or anxiety, experiencing strong residual cravings for a substance, using other substances than the initial substance that led to treatment, unresolved trauma and other negative life events, impulsivity, and biological vulnerabilities (Sliedrech et al., 2019; Stillman & Sutcliff, 2020). As can be seen from these factors, having a facility approved for handling Dual Diagnosis care, like BeWell’s Treatment Centers, is essential to recovery success. Thus, many pitfalls in the addictions recovery process can lead to relapse and rehospitalization, but through relapse prevention strategies many patients go on to long-term success in their recovery.
Evidence-Based Relapse Prevention Strategies
Relapse prevention is an essential component of any JCAHO Accredited treatment center. Preparing patients for risk factors and experiences that could lead to a relapse in addictive behavior is one of the best ways to reduce their risk for relapse over the long term. When patients near the end of a rehabilitation program, it’s tempting to focus primarily on the success they’ve had so far. While it is important to acknowledge how far a patient has come in recovery, as noted before, the biggest challenges with long-term success arise after completing treatment. Key factors for long-term recovery maintenance include having a supportive social network, building confidence in one’s coping skill set and identifying positive purpose and meaning in life outside the context of alcohol or drugs (Sliedrech et al., 2019). In addition to these factors, implementing evidence-based approaches to relapse prevention through cognitive behavioral therapy (CBT) and contingency management are also essential to preventing relapse (Marlatt & Donovan, 2005).
With CBT relapse prevention approaches, patients learn what factors in their lives are most associated with cravings for a drug, and patients are taught how to address distressing internal emotions and thoughts associated with cravings in a way that reduces the likelihood of using a substance. Sometimes specific people or places were a major part of substance use and engaging with them may be problematic for some patients. Patients are taught effective situational and cravings management strategies, how to avoid triggers for cravings when possible, and effective coping responses when cravings arise (Hendershot et al., 2011). Indeed, the possession of a relapse prevention toolkit also gives patients confidence to maintain recovery, knowing they can handle whatever life may throw their way. In addition to traditional CBT relapse prevention strategies, additional work has been done to demonstrate the effectiveness of mindfulness-based relapse prevention strategies that particularly focus on the healing and cravings-control capacity of mindfulness meditation (Bowen et al., 2014). Lastly, even when a patient struggles with a return to problematic substance use behavior or a full potential relapse, the best thing a patient can do is actively seek extra therapeutic support and potential re-hospitalization. While the goal is to avoid re-hospitalization, if possible, re-hospitalization is still a much better, preferable, and healthy outcome than giving full power back to addiction and allowing the addiction’s return to destroy a recovered patient’s life once again!
Conclusion
Relapse prevention treatment strategies are vital to success with long-term addictions recovery, which is why JCAHO Accredited and Dual Diagnosis approved programs like those at BeWell Network Treatment Centers offer individual and group therapy approaches providing evidence-based relapse prevention support. It’s also helpful for patients and families to conceptualize addiction as a chronic condition (McLellan et al., 2000), and some difficulties or even steps backward in the addiction recovery process are to be expected. If at some point a patient needs to be re-admitted to a rehabilitation center, re-hospitalization should be viewed as essential to health and well-being, rather than an indication of failure on the individual’s part. What matters more than personal feelings of self-disappointment, which are common when many patients return to substance use behavior or outright relapse, is that patients return to treatment and recommit to beating addictive behavior. For some, freedom from addiction is a lifelong struggle, but recovery and freedom from the burden of addiction are worth fighting for!
References:
Andersson, H. W., Wenaas, M., & Nordfjærn, T. (2019). Relapse after inpatient substance use treatment: A prospective cohort study among users of illicit substances. Addictive behaviors, 90, 222-228.
Bowen, S., Chawla, N., & Witkiewitz, K. (2014). Mindfulness-based relapse prevention for addictive behaviors. In Mindfulness-based treatment approaches (pp. 141-157). Academic Press.
Ignaszewski, M. J. (2021). The epidemiology of drug abuse. The Journal of Clinical Pharmacology, 61, S10-S17.
Marlatt, G. A., & Donovan, D. M. (Eds.). (2005). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. Guilford press.
McLellan, A. T., Lewis, D. C., O’Brien, C. P., & Kleber, H. D. (2000). Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. JAMA, 284(13), 1689-1695.
Sliedrecht, W., de Waart, R., Witkiewitz, K., & Roozen, H. G. (2019). Alcohol use disorder relapse factors: A systematic review. Psychiatry Research, 278, 97-115.
Stillman, M. A., & Sutcliff, J. (2020). Predictors of relapse in alcohol use disorder: Identifying individuals most vulnerable to relapse. Addiction and Substance Abuse, 1(1), 3-8.
Wemm, S. E., & Sinha, R. (2019). Drug-induced stress responses and addiction risk and relapse. Neurobiology of Stress, 10, 100148
Dr. Edward Selby is a licensed psychologist and an Associate Professor of Psychology in the Rutgers University Department of Psychology. Dr. Selby specializes in the research and treatment of suicidal and self-injurious behavior, personality disorders, and eating disorders, with a particular focus on emotion regulation and harmful behaviors like binge eating, substance use, and self-injury. Dr. Selby has published extensively in these areas, with over 100 publications appearing in premier outlets such as Clinical Psychological Science, Journal of Abnormal Psychology, Clinical Psychology Review, Behaviour Research and Therapy, and Psychological Review. Dr. Selby’s research has been funded by organizations such as the National Institute of Mental Health, the Brain and Behavior Research Foundation, and Janssen Pharmaceutica, and private philanthropists.
His work has been recognized with multiple awards including an International Academy of Suicide Research Young Investigator Award for 2013, NARSAD early investigator award, the Neil S. Jacobson Award for Outstanding and Innovative Clinical Research, and in 2015 Dr. Selby was name a Rising Star by the Association for Psychological Science. In addition, his ongoing program of research, Dr. Selby serves as the Director of Clinical Training for the Rutgers Clinical Psychology Ph.D. program and regularly teaches graduate level adult psychopathology and applied latent variable modeling and hierarchical linear modeling. Dr. Selby is a Data Analyst and Researcher at the BeWell Network, where he is responsible for clinical service effectiveness evaluation and research dissemination.
