Whether or not relapse is a “normal,” or even necessary, part of drug-addiction recovery is debatable. What’s not debatable, and where consensus is virtually unanimous, is that relapse occurs at a relatively high rate—40 percent to 60 percent, according to a Journal of the American Medical Association study cited by the National Institute on Drug Abuse (NIDA). In order to determine if you should return to rehab, it is first important to fully understand relapse and the dangers it presents.
What Is Relapse?
Defining “relapse” also can be tricky, and depends on various factors, including the drug involved, specific patient criteria, and the treatment method employed. To understand relapse, one must first recognize successful treatment factors. The Office of National Drug Control Policy defines effective drug abuse treatment as:
- Reducing the use of the primary drug, drugs, or alcohol.
- Improving the employment status or prospects of the patient.
- Improving the patient’s educational situation, where appropriate.
- Improving relationships with family, friends, employers, and other associates.
- Improving the patient’s medical condition and overall health.
- Improving the person’s legal situation regarding prison, jail, probation, parole, driver’s license status, and arrests.
- Improving the patient’s mental health condition.
- Reducing the person’s noncriminal safety incidents, such as car accidents, injuries, and emergency room visits.
Simply defined, relapse is the return to a previous situation regarding drug or alcohol use. Regardless of how long someone’s been sober, a return to substance abuse is a relapse. According to the American Bar Association’s GPSolo magazine, “Relapse is the return to alcohol or drug use after an individual acknowledges the presence of addictive disease, recognizes the need for total abstinence, and makes a decision to maintain sobriety with the assistance of a recovery program. According to a survey of members of AA, 75 percent experience a relapse during their first year of recovery. For those who are sober five years, the rate drops to seven percent.”
Lapse Vs. Relapse
You may wonder if there is a difference between a slip, or a “lapse,” and a true relapse. A lapse is a temporary, often one-time, return to prior drug-use behavior, whereas a relapse is a “full-blown” return to drug or alcohol abuse after an attempt to quit. To better understand this concept, we’ll compare drug addiction lapse and relapse to a person trying to lose weight and maintain the weight loss. Eating a single piece of pizza, for instance, would be considered a lapse. Gaining 35 pounds during the course of dieting from a continued poor diet, would be considered a relapse.
Why Do People Relapse?
Many factors may contribute to a person relapsing. Primary causes of relapse include: medical problems, mental health issues, failure to follow through with aftercare conditions, over confidence in treatment progress or recovery, forgetting or ignoring painful lessons from the “good old days” of substance abuse, stress, a lack of support, issues with family members and friends, and job issues or lack of employment.
Lack of commitment to sobriety can also be a major factor in relapse. Here, we provide a thumbnail view of four stages of recovery used in many treatment programs, including, pre-contemplation, contemplation, preparation, and action. Often, during the pre-contemplation stage, and even into the contemplation phase, a person may not even consider his or her behavior a problem, however, he or she eventually realizes that the negative consequences are mounting. This can lead to the contemplation stage, although people may fluctuate between either or both of these phases for years before actually moving on to the preparation and action stages. Sometimes, a person may relapse back to one of these stages, as they struggle to maintain their recovery.
Outside pressures—from family members, friends, co-workers, or even via legal issues or court-ordered rehab mandates—can also put people at risk for post-rehab relapse. A person may enter rehab while still in the pre-contemplation stage and simply not be committed to the process, potentially increasing the risk of relapse.
This lack of commitment, among other factors, is often cited for the “revolving door syndrome,” or a cycle of treatment, relapse, and a return to treatment. A person might be ambivalent about recovery, seeking treatment not for themselves but for external reasons. Other people may fear the unknown, as they don’t know how to live outside addiction. Unrealistic expectations are another factor, including the belief that sobriety will cure all of life’s problems. Many people also fall into the trap of making changes only regarding drug or alcohol use, while ignoring other necessary lifestyle changes.
There are many myths surrounding relapse, some deeply ingrained and widely held. If not addressed thoroughly in rehab, these beliefs can lead to relapse after rehabilitation is complete.
Here are five such myths that can lead to relapse:
- All people who suffer from drug or alcohol abuse will relapse. This fallacy can lead to a “self-fulfilling prophecy” and relapse.
- People who relapse aren’t committed. Lack of motivation may, indeed, be a factor, however, many highly motivated people also relapse.
- Relapse only occurs by returning to your drug of choice. Choosing to abuse another drug may return you to an addictive and dysfunctional state.
- Relapse means that a person is back to square one. Again, a person doesn’t have to relapse, but it is important to remember that knowledge can be gained from this experience that may be useful within the next attempt at treatment and in avoiding future relapse.
- If a person relapses, it means that rehab treatment failed. A drug treatment regimen may need adjustments to be successful or another program may be beneficial.
While many critics point to low success rates of drug rehab programs as evidence of failure, the fact is that alcohol and drug treatment relapse rates compare to the relapse rates of treatment modalities for physical conditions—over which people have ostensibly less control. For example, where the relapse rate for drug addiction is 40 percent to 60 percent (according to NIDA), the relapse rate for Type I Diabetes is 30 percent to 50 percent, and 50 percent to 70 percent for both hypertension and asthma.
Dangers Of Relapse
Aside from problems typically associated with addiction, relapse can be especially dangerous for many people for several reasons. First, a person’s tolerance is reduced through abstinence, so a drug overdose is a distinct possibly—especially with opioids like heroin. This is due to physiological changes in an addicted individual’s body, according to Dr. James C. Garbutt, Professor of Psychiatry and addiction specialist at the University of North Carolina, as reported in a Huffington Post article.
In regards to this, Dr. Garbutt is quoted as saying “When you’re actively using opiates, that center can adapt to the exposure, allowing addicts to use more or in greater concentration without the respiratory system failing. But when people get sober, the receptors in their brain and the chemical mechanisms which process the drug become more sensitive, and the reaction to the opiate becomes more pronounced. The longer you’re sober, the more the brain will attempt to adapt back to its normal state.”
Huffington Post also quotes Dr. David Sack on this subject, who asserts “It’s (also) important to realize that many of the overdoses are in the first few doses, because by the time an addict re-establishes their addictions, they have tolerance again. This is someone who is deciding whether they are going to be sober or not. So craving is a big factor—being preoccupied with procuring drugs increases and escalates in the first days after treatment.”
In a NIDA article titled “America’s Addiction to Opioids: Heroin and Prescription Drug Abuse,” the high risk of overdose during relapse regarding opioids was further explained. “This tolerance contributes to the high risk of overdose during a relapse to opioid use after a period in recovery; users who do not realize they may have lost their tolerance during a period of abstinence may initially take the high dosage that they previously had used before quitting, a dosage that produces an overdose in the person who no longer has tolerance.”
Should I Go Back to Rehab?
Although each person must determine for himself or herself whether or not a relapse calls for further treatment, we highly recommend it. Here are a few guideposts to consider to help with this decision. The first probably is defining the “relapse” in question—is it a stumble, or “lapse,” or is it a fully realized backslide or true relapse? Ask questions. Did you have a single beer at a cookout before coming to your senses, or did you go on a week-long bender, black out, and begin compulsively using again?
If you determine that you have experienced a true relapse, reentering rehab may be your best option. However, practical matters must also be considered. Can you afford another stay in rehab? Does your insurance cover the cost? How long will you be in treatment? How does such a decision impact your job and finances? Are you truly committed or are you responding to external pressures from family or friends? Do you want to reenter a facility where you previously were treated or would it be better to research other options? Have you identified the reasons for your relapse?
If you’ve determined that you actually need to enter rehab, consult a professional, especially if issues like cost or insurance coverage are the main stumbling blocks. Assistance often is available.
Get Help If you Have Questions Or Concerns
If you’re considering reentering a rehabilitation facility for concerns related to relapse or entering for the first time, and you have any questions or concerns, contact us at DrugRehab.org, or call 1-833-473-4227.
National Institute on Drug Abuse — Drugs, Brains, and Behavior: The Science of Addiction
Office of National Drug Control Policy — Treatment Protocol Effectiveness Study
American Bar Association: GPSolo — Relapse After Long-Term Sobriety
Huffington Post — What Drug Relapse Has To Do With Accidental Overdose Risk