Too many of us don’t realize that substance use disorders are chronic illnesses, like diabetes and hypertension. Just as relapse occurs with patients having those two very common chronic illnesses, relapse with individuals suffering from substance use disorders also is possible and does in fact happen.
What causes one to relapse?
Experience with this unfortunate part of substance use disorders has taught us that although there are many explanations for why relapse takes place, the following seem to be the most predominant factors why substance use disorders recur:
- Stress – Difficulties dealing with the stressors of work, relationships, finances, and daily life tasks and obligations is a common cause of relapse. Everyone experiences stress to some degree but if not dealt with in a constructive manner it may endanger one’s recovery.
- Not changing people, places, and things – Not changing the ‘who, what, and where’ associated with one’s substance use disorder also is a primary reason why individuals relapse, especially those in early recovery. It is essential that the old behaviors and environmental triggers are removed or modified in order to maintain change and stability.
- Negative emotions – Harmful emotions like anger, anxiety, frustration, and loneliness will often trigger the old, unhealthy thought processes. These often lead to resentment, self-pity, and frustration that in turn results in an increased potential for relapse. Twelve Step programs use the acronym HALT as a reminder: “Hungry, Angry, Lonely, Tired.”
- Depression – Frequently referred to as the ‘sister disease’ to substance use disorders. Because depression is such a common element of substance use disorders, undiagnosed or misdiagnosed depression – hopelessness, feeling worthless, low or no energy, inconsistent appetite and sleep patterns, irritability, lack of interest – is another factor causing relapse. If there is no joy in sobriety it becomes difficult to not use substances you know will make you feel better. If these feelings persist, it is important to talk to a counselor or health care professional about ways to treat these symptoms.
- Complacency – This occurs to most people in early recovery, they start questioning whether they need to keep going to outpatient treatment or 12-Step meetings. Wondering if they really do need to continue treating their substance use disorder or if they have one. At this point, it is very important that the person discuss these thoughts and feelings with a close sober support; someone to help them understand that these thoughts are normal, but also very dangerous. Once someone starts to question the need to treat the disease, relapse is imminent unless steps are taken to control it.
Medically and clinically stabilizing patients suffering from substance use disorders is certainly key to successful treatment. But there needs to be more than just stabilization to help prevent relapse. Outpatient treatment and active involvement in sober community support groups are imperative to ongoing recovery. People need to find sober activities that reinforce the benefits of being clean and help maintain abstinence as a priority.
We have found preventing relapse depends to a large degree on successfully employing the following treatment objectives, to help ensure that patients recognize and know what to do when the causes of relapse mentioned above appear:
- having patients gain knowledge and acceptance of the chronic illness (‘disease’) nature of substance use disorders
- having them learn and use coping and sober living skills
- having them establish and maintain sober support systems
- helping them understand and comply with an appropriate level of aftercare (medical and clinical)
Nothing can guarantee that everyone treated for substance use disorders will avoid relapsing. Yet we know that individuals, who engage in treatment with providers that incorporate evidence-based therapies and programming, can and do achieve high rates of abstinence with low rates of relapse.