Addiction is partly defined as a “chronic and relapsing disease.” In this way, similar to an ailment like diabetes, it takes daily work and lifelong commitment to manage addiction and remain abstinent. The idea is that addiction can be treated, and one can live a joyful life, but it cannot be cured. However, relapses do happen. And, unfortunately, the statistics show that they happen frequently. A relapse is simply a return to using substances of addiction. For addicts, this is an extremely dangerous occurrence due to the risk of physical craving for the substance recommencing, and leading to an uncontrolled binge that can destroy one’s life and even be fatal.
The relapse rate for those engaged in recovery has been estimated at around 40%-60%. (https://www.drugabuse.gov/) What this means is that out of all the people who attempt to stop using substances, 40% to 60% will return to use at least once within one year. This does not mean that they won’t recover eventually. This statistic also does not take into account the myriad approaches to recovery that people take. A person who simply swears off drinking is of course more likely to relapse than someone who attends a 90-day rehab, lives in sober living, and works on trauma and mental issues with a therapist while also regularly attending AA meetings. So the journey to recovery and the relapse rate is truly varied. It is clear that the longer one stays in formal treatment, and the more engaged one is with a recovery community, the better the chances of achieving long-term sobriety. In any event, it is best for the recovering addict to understand the possibility of relapse and to be aware of its potentially disastrous consequences.
There are many signs of an impending relapse and it is important to create a “relapse prevention plan” (which your therapist can help you with) in order to identify these and nip them in the bud. Stopping working on a 12-step program, isolating, an increase in anxiety or depression, or excessive engagement in cross-addictions like eating or shopping can all be warning signs. They signal a sort of “emotional decay” of sobriety which can lead to a relapse.
This blog post is primarily focused on dealing with the aftermath of a relapse, either your own, or a friend or loved one’s. It is my own experience that the primary issues following a relapse are guilt, dismay, and physical craving.
I believe that almost all addicts want to stay clean, and desire a better life free of substances. Many of us form amazing friendships in recovery as well as strong, deep bonds with our therapists and sponsors. We rebuild our family relationships and work relationships. We do not want to “let these people down.” A feeling of having let others down, or having others know that we slipped into substance use, can create very strong feelings of guilt. Additionally, many 12-step programs like AA seem to champion the idea that “if you follow this program you will not relapse.” A relapse can make us feel like we are not working our recovery program properly, that we have been lazy or sloppy or even just not smart enough to follow the 12-steps. These notions also lead to serious guilt.
If you are desperate to be sober, and making good progress toward rebuilding your life and relationships, and working hard with therapists and in a recovery program, it is easy to think that you are in the clear. After all, everything is going great, people are telling you how great you are doing, and you’re even helping other recovering addicts who are newer to sobriety. The discovery then, after a relapse, that addiction is perhaps more complicated and dangerous than you thought, or that there are still lingering triggers or emotional issues that you haven’t dealt with and which have led you to use, can be very dismaying and disheartening. AA declares alcoholism to be “cunning, baffling, and powerful.” It can stay dormant for years until a powerful trigger you are not prepared for, like a break-up, job loss, or even something good like moving to a new house or getting a big raise, destabilizes you. The dismay at this realization is very real.
3. Physical craving.
Biologically, the bottom line is that addicts cannot put substances in their body safely. Ingesting an addictive substance leads to a genuine reaction in the body that causes craving, loss of control, and, eventually (whether it is a day, a week, or a month of attempted controlled use later), a destructive binge that might end in a hospital, jail, or death. We may stop drinking or using the day after our relapse, but our brain may have been neurochemically jolted out of recovery and “reminded” of the pleasure of intoxication. Craving may set in after a relapse and make it all the more difficult to climb back to sobriety, as intrusive thoughts of using and desires to continue using become strong.
How can we deal with all of these things (and others, such as perhaps a job loss, an angry spouse, or a legal issue) that follow in the wake of a relapse? It is not easy. The best approach, and which really might be the best option, is to return to a residential treatment center. This approach takes the stance that a chemical relapse is preceded by a long period of emotional decay and a weakened lifestyle of sobriety that will take work to fix. Additionally, this approach respects the seriousness of the revived physical cravings experienced by relapsed addicts. Residential treatment fully and completely removes the addict from substances, allowing us to be in a safe environment while the brain heals again. There really is no substitute for returning to a residential rehab in order to help ensure a solid, enduring recovery from a relapse.
Jumpstarting one’s program of recovery is important. Go to more 12-step meetings, find a new sponsor, restart the 12-steps, return to therapy or work more with your therapist. Examine your relapse and see what lessons it taught you. Where had you fallen short in your recovery? Had you stopped exercising? Isolated? Or maybe you had jumped into a turbulent romantic relationship or started a new job without being honest with yourselves and others about the difficulties such things posed for your sobriety? There are many, many reasons for a relapse and we each have to explore them for ourselves and work on solutions.
I think it is important to be gentle with ourselves and with others who have relapsed. Connection is the opposite of addiction and a relapse should not drive someone into further guilt, shame, or isolation because they feel like their friends have been let down or are being judgmental. AA, in particular, sometimes seems tacitly judgemental about relapses, which is something I think the program could improve upon. Being loving, supportive, and encouraging is, I think, the absolute best way to help yourself or another get over a relapse--even if the relapse has disrupted your life and led you to return to residential treatment. Addiction is not simple and overcoming it is not easy. At times it is akin to trench warfare--a life-and-death attritional struggle that pits your soul and spirit against the disease. Recovery is often two-steps-forward, one-step-back, or even one-step-forward, two-steps-back. The most important thing is having the courage and resilience to never, ever give up, and the wisdom to learn from mistakes, and a loving group of people around you who are there to support you.