To understand issues surrounding recovery and the prevention of relapse, it’s important to first understand addiction and the components of recovery and relapse.
The American Society of Addiction Medicine provides the following definition: “Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response.” Essentially this means that an addiction is tied to a compulsion that the addicted person has little ability to control. When we talk about addiction, there are two types to consider.
- Physical: Physical addiction is the body’s need for an addictive substance, typically as a result of exposure to said addictive substance. An example would be mothers who use drugs while pregnant whose children are born with a physical addiction to the substance they are used to having.
- Psychological: Psychological addiction is more of a desire or perceived need of the person suffering. Often, this comes from individuals using substances or activities as an escape or distraction from other aspects of life. For example, it has been widely documented that there is a link between traumatic stress and addiction. This is especially common in those who suffered sexual abuse as children. Drugs, alcohol and addictive activities are often an escape from mental trauma and stress, and those who have experienced abuse are some of the most vulnerable to being victimized by addiction.
The National Institute on Drug Abuse defines dependency as the process in which “the neurons adapt to the repeated drug exposure and only function normally in the presence of the drug.” This means that the brain and body have adapted to the drug and cannot function properly without it. When the addictive substance is removed, patients go through withdrawals presenting as physical illness.
Recovery is the action of stepping away from addictive substances or activities and working to live an addiction-free life. Both addiction and recovery are processes that include much more than what’s on the surface. There are many factors that contribute to addiction. In the same way, recovery and relapse are a culmination of different contributing factors.
Lifestyle and Social Changes
One issue that many people face in recovery is the issue of lifestyle change. While living in a treatment center, people are more easily able to see the potential for positive change, but upon returning home, they face their old life and old habits. Often, people have to stay away from old friends or even family members who are a negative influence in terms of drug or alcohol use. Some people find it very difficult to not use in a location that reminds them of their past drug use and the events that led them to start using in the first place. If a person cannot separate their home, their family or their social circle from their history of drug abuse, they must find a way to remove themselves during the recovery process.
There are several medical treatments available to address addiction. Physicians may prescribe certain medications to help patients recovering from addictive issues. These medications serve different purposes in the process. Some medications are prescribed to help mitigate the effects of withdrawal while others are designed to affect the brain, decreasing the desire for addictive substances. Medications are also utilized to treat underlying issues that impact addictive personality such as anxiety and depression.
Mental Health Treatment
Underlying mental health issues are often a driving force behind addiction. Addressing these mental health concerns is a big part of treatment. Some people use drugs to calm their mind if they suffer from anxiety or other disorders like ADHD. Some people use addictive substances to boost their mood and cognition if they suffer from depression. This self-medicating can get out of hand and lead to a new set of problems. The goal of the mental health approach is to allow the person to find and utilize methods of coping with illness that do not lead to drug use. The mental health method of treatment can take on many forms, including one-on-one counseling, group therapy, mood-balancing medications and even hypnosis.
While it’s important to understand that there are many options for recovery, it is equally important to understand the components of relapse.
Contributing Factors to Relapse
Relapse is a step backward in recovery. Relapsing could be described as falling back into old behaviors. This is when someone in recovery has one more drink, smokes one more cigarette or takes drugs again after being off of them for a period of time.
Relapse is, unfortunately, a common event on the road to recovery. There are several reasons for this. First, it must be noted that addiction is very real and difficult to overcome. Imagine trying to stay away from something as your brain and body constantly tell you that you need it. Also, environmental issues play a big role in relapse. It’s difficult to recover successfully in the same place you used to feed your addiction. Furthermore, issues like poverty and poor family structure can affect relapse. According to research from Robert Kaestner in 1999, the chances of abusing marijuana and cocaine increase dramatically for those living in low-income environments.
Physiological factors include physical dependence, withdrawals and underlying physical ailments. Consider that there is currently a serious opium epidemic in the United States. This opioid crisis is in part due to people who become addicted to prescription painkillers. These are legal medications that are distributed for legitimate medical reasons, but they are habit-forming substances. In this situation, we have people who did not seek out illicit drugs but rather became addicted after trying to address their own physical pain. For those in recovery for issues with prescription painkillers, the problem is twofold. Not only is the addicting nature of the substance itself a factor, but the original physical issue the painkillers were prescribed for may still be an active problem. Not only do these people have to deal with the psychoactive, habit-forming aspects of the medication, but they may have to suffer with physical pain alongside withdrawals when stopping the medication.
Mental Health Factors
According to the National Institute of Mental Health, an estimated 16.2 million adults in the United States have had at least one major depressive episode in the last year. This accounts for 6.7 percent of all adults in the United States. Depression is a serious but common health problem that can result in psychological impairments and interfere with or limit a person’s ability to carry out major life activities.
For people suffering from depression, motivation is difficult. Just getting out of bed can be a challenge, so the challenge of achieving sobriety can be greatly inhibited by depression. Those who suffer from extreme anxiety may find it unbearable to make it through life without using a substance to quiet their minds. Sometimes, this leads people back to their drug of choice and brings recovery to a halt. Some people may have mental disorders in which the only way they feel normal is by being under the influence of drugs or alcohol. Clearly, we see the very serious issues that can arise from mental health issues alongside drug abuse.
Social factors are possibly the biggest issue leading to relapse. If a recovering individual returns from a treatment center to their old neighborhood and to all their old friends who are still using, it is much more difficult to stay on track. Imagine being on a diet and going to an all-you-can-eat buffet. Imagine saying that you are going to sit at the buffet but only have a salad. This is what it’s like to be on the road to recovery surrounded by those who are still on the path of addiction. Outside influences greatly impact a person’s personal success, and being around negative influences often leads to negative results.
Once we understand the issues that interfere with recovery, we can begin to understand the components of relapse prevention.
It is important to understand the building blocks to success. Five key components are as follows.
People sometimes find comfort in the things that are harmful to them because there is comfort in the familiar. Recovery is a big change, and change is scary. For this reason, a well-structured plan is immensely helpful. Lack of structure and planning can lead to chaos and stress, which makes old unhealthy habits more appealing. The old phrase holds true that journeys of self-improvement should be taken one day at a time; however, if your days lack structure, it’s hard to move forward.
Identification of Triggers
Whether it is mental or physical, internal or external, there is something that pushes an addict into relapse. Maybe it’s a trauma from the past, a sight or smell, or something someone says that sets a person off. Regardless of what it is, relapse prevention is only possible if you can identify what triggers you to relapse and figure out how to work around it.
You can’t succeed without a goal. Just trying to not do what you did before will not cut it. People need something to work for, not just something to work against. Goals can be daily or lifelong. Your goal could be to stay sober for a week or to make it through the day. Your goal could be to see your children grow up and be successful. Your goal could be anything, but you have to keep your eyes fixed on a goal. You need something to work for, and you have to work for it.
Lifestyle change is a huge factor for a lot of people transitioning into a life of sobriety. If you want a life different than the one you had before, it’s not enough to say, “I’m going to quit drinking” or I’m going to quit doing drugs.” You have to look at what factors in your life put you on the wrong path and what changes will help put you on the right one. A strong support system is part of making lifestyle changes that last.
While this is a personal journey, it is vital to be surrounded by people who will help and not hinder. This community of support can be those who have been where you are in addition to those who have no idea what you are going through. The important thing is that they are people who care and will help you along the way. Many people develop lifelong friendships with people they met in groups and programs for recovering addicts. These bonds are extremely helpful because they connect people who understand and have had the same struggles.
Support from outside is equally important because there is a stigma associated with addiction, and getting support from those who are not themselves struggling with substance use helps to make recovering users feel less alone in the battle. To succeed, you must have a community that will build you up and catch you if you fall.
As you can see, the treatment process is not a simple one-time event. Recovery is a lifetime process, and it takes dedication to relapse prevention and positive change. This multilayered issue is physical, mental and emotional. It is not easy, and it might take everything you have. However, with the right tools and the right attitude, recovery is certainly within reach.