Recurrence is a common feature of chronic diseases, including substance use disorders (SUDs). Rates of relapse for SUDs are comparable to those for diabetes, hypertension, and asthma — about 40 to 60 percent, according to the National Institute of Drug Abuse.
What really is relapse, why does it happen, and how do you bounce back from it? For answers, we reached out to Joi Honer, who is FHE Health’s Director of Alumni Services. Honer has a deep reservoir of knowledge about the topic, both as a clinician and as someone in recovery for more than four decades. Catch her insights in the below Q&A….
The Definition of Relapse
Q: What is a relapse?
A: To define a recurrence, it helps to define what recovery is. Recovery, according to SAMHSA (the Substance Abuse and Mental Health Administration), is “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” By that definition, you can have a recurrence and still be in the process of recovery.
Q: What’s the difference between a slip and a full-blown recurrence?
A: The difference is whether you slip and get right back up or if you stay down on the ground.
Either one is a recurrence, but one of them has more significant context. Regardless of which one of those scenarios happen, it is a myth that people lose everything when they return to use. If you’ve had four years of sobriety, you can’t say that all that work didn’t position you to rebound in a better place. When we apply what we have learned in the past to our new attempts, it may help us identify behaviors that can prevent us from returning to use in the future.
Is Relapse Normal?
Q: Why do so many people relapse after rehab? Is relapse normal during recovery?
A: Yes, as with any chronic disease, if we use the disease model, recurrence of the symptoms of that disease is quite common. It perpetuates stigma to imply otherwise.
Q: Why do so many people relapse after treatment?
A: You could ask the same question with hypertension or diabetes, because people can return to old patterns of coping and behaviors. Human beings seek comfort and often find that comfort in what they are used to. And, when relapse rates for substance use disorders are similar to those for diabetes and hypertension, part of the answer is to ask why people see recurrences with SUDs as more problematic or shameful than with other chronic diseases. There’s always that stigma, which carries a weight that can negatively impact someone’s attempt to get back on track.
Changes in Behavior Are Often Hard
Recovery requires changes in behavior, and sometimes people have relied on those behaviors for a very long time. Historically, people have a recurrence of behaviors that could lead to a cardiac situation like managing cholesterol, and people don’t necessarily do those things that are good for them. Similarly, in recovery from SUDs, people may have issues with relationships and communication, like asking for help, or with self-examination. All those things that help someone recover can have barriers, so recovery can take several tries. What doesn’t help is the
shaming of a person who is already struggling.
Finding the Right Treatment Can Take Time
It’s also possible that the right combination of treatment may not have been achieved, because everybody has diverse needs. Some people with diabetes or heart disease must change their diet or take medication. There’s no one set of solutions that works for everyone. The level of complexity of an individual’s recovery path is too unique and challenging. As with other disorders, there’s no one guaranteed, prescribable way that every person will recover.
The Perfect Storm Happens
When somebody attempts recovery, a perfect storm of things can happen that either leads them towards the path or from it. Some of it is controllable, but a lot of it may not be. Someone goes to work and learns that they’ve been fired; then when they go home, they learn their wife has left them. Life keeps “life-ing,” and no one can predict every outcome. There are nuances to identifying the right combination of getting to the right place, the right treatment, the right med, and the right sponsor, etc.
The Biggest Causes and Triggers of Relapse
Q: What are the biggest causes and triggers of relapse?
A: Emotional triggers – An emotional cue or trigger such as stress, anxiety, the past, grief, or depression can create a recurrence in someone who is early in their recovery and less practiced at managing their feelings. This is also why all those levels of care in the earliest stages of recovery are important: Without practice, structure, and accountability, people will return to the coping mechanisms they’ve known best.
“People, places and things” – Certain people — an old drinking buddy or family members who are unhealthy or not supportive — can be triggering. So can places, like a neighborhood bar or your front porch, and things, such as music, a concert, or a favorite party shirt.
Untreated mental health issues – Not managing mental health issues concurrently with recovery from substance use can cause relapse. Sometimes it’s hard to tell which came first, the chicken or the egg.
Unresolved trauma – Some people absolutely must address things like trauma in their early recovery. However, others must put issues such as this on the back burner, so they can practice their recovery skills before diving into significant emotional work. Often, professionals can help with some of these decisions.
If things get good fast – If things get good fast, people can get scared. Success can create anxiety, fear, and a lot of pressure. Someone may be comfortable in the scapegoat, troublemaker, or rebel role and used to that; or the opposite of that can be believing that because all the things in my life are going how I want them, I don’t have to maintain my recovery. People may lose touch of their need to tend to themselves because they have all these wonderful things. Yes of course, maintaining mental health requires ongoing work. It will get easier, but we still have to tend to our mental health regularly.
Isolation – People are more vulnerable to relapse when they have withdrawn from their support network and relationships.
Typically, it’s not just one of these things, but a combination of them that results in a recurrence.
How to Recover Mentally After a Relapse
Q: How do you recover mentally after a relapse?
A: The first thing is to reach out and get support. The best way to do that is to reach out to someone who is a safe person to disclose that to, somebody who is not going to shame you but can manage a recurrence without reacting.
Next, it’s important to address the self-blame and shame that comes with a recurrence, by talking about it, not giving it space, and getting active. This goes back to social support and
finding ways to not allow yourself to ruminate and blame.
Once you’ve begun to move back into those behaviors that have supported your recovery in the past, it can be helpful to re-engage in therapy or, if you’re on medication, to reach out to your doctor about whether your medication is working effectively or needs to be tweaked.
Looking at the cues — reexamining what led up to a recurrence and identifying any patterns, issues, or missteps that could’ve contributed to it — is also important work. But always be prepared for the answer that sometimes a recurrence just happens.
Relapse Prevention Tips
Q: How can you prevent another relapse?
A: When you reflect on the cues that may’ve set you up for that situation, it’s always good to re-examine the things that happened and reflect on what might need to change. Remind yourself that all your hard work is not lost and you will retain some of those lessons and experiences thar you’ve learned along the way. They didn’t fly out of the window with one recurrence. That would be like saying that everything you learned at the age of thirteen, you’ve lost.
Other tips:
- Seek to increase your skillset in managing stress – Increasing the tools in your toolbox for stressful events and situations before you encounter them is one way to avoid recurrence.
- Have self-compassion – Look internally at that self-narrative to be sure you’re being kind and supportive just as you’d be with a friend who is struggling.
- Practice gratitude – Practicing gratitude is a significant way to avoid a recurrence. If we don’t appreciate what we have, we won’t work to keep it.
- Maintain and invest in your support system – Be active in recovery support systems and make sure your support system remains intact. Think about what additional support you might benefit from and consider relationships in your life that you might need to let go of.
- Remember that there are different phases of recovery – What you did to support early recovery may impede recovery later in the process. Growth and recovery require that we keep an open mind about what may work for us as we grow.
- Increase your participation in support meetings when you are struggling – Many people think that’s a step back, but it’s just a natural part of life and the ebb and flow. The same is true with therapy.
- Address your physical wellness – In recovery we often focus on the internal, but being active is both mentally and physically positive. Be mindful of healthy eating habits and get adequate rest. Even a little bit of movement such as walking can improve mental health.
- Seek treatment – If you find yourself in a situation where you’re not successfully able to bounce back, get help.
Finally, the voice inside you that tells you there is no hope is a liar. There is always hope and choice. There is hope every time you choose to reach out for help, support, direction, or change, whether it’s your first recurrence or your 30th. If there is one takeaway from this, it’s that if there’s life, there’s hope.
