What You Need to Know About Relapse

by Marcus Abernathy

This is an important blog, so I will begin with my conclusion because it’s the most important part of this.

If your loved one relapses, remember these 4 things:

1)     Be gentle.

2)     Do not give up hope; it’s not the end of the world.

3)     No matter how hard we try, we don’t get everything right the first time.

4)     Take steps to get support for yourself.

Having a loved one in recovery can be challenging and rewarding at the same time.  On one hand, you can be proud of them for abstaining and “doing the work.”  On the other hand, statistics show that the odds are not in their favor.  Is there a relapse lurking out there somewhere?  If so, how do you deal with it?  What does it mean?  Are we back to square one?  Was all of this money spent on treatment, doctors and therapists for nothing?  How do we start over?

These are just a few questions that can come racing into your mind upon hearing that a loved one in recovery has slipped up.  It may feel like the end of the world.  It may feel like betrayal.  It may cause feelings of anger or shame.  It could feel hopeless.  And it could feel like you just cannot handle it anymore.  All of these feeling are valid; they are in fact your feelings.  But relapse is not the end of the world, and hopefully after reading this, your mind will be a little more at ease on this difficult topic.

What happens during a relapse?

The first thing to know is that relapse is not synonymous with failure, nor does it mean one has given up.  You must remember that no matter the duration, your loved one has some sobriety under their belt.  Otherwise it wouldn’t be a “re”lapse.  And just because he or she slipped up, doesn’t mean they weren’t putting forth effort.  We don’t always get it right the first time, no matter how hard we try.  And I’m not just talking recovery here, rather life in general.  Those recovering from addiction are undergoing intense cognitive and behavioral reprogramming of flawed survival mechanisms conditioned in their limbic system.  This takes time, and it is not easy.  Desire and willpower are simply not enough to overcome the urges to use because they are conscious mechanisms.  One may wish to stay sober, and think they are strong enough to just say “no,” then relapse and be left wondering “what the hell happened?”

Something most don’t understand is that the relapse is not the act of using again.  Instead, relapse begins with a thought process, usually set in motion to a subconscious “trigger” in the addict’s environment.  A trigger is any external stimulus that activates a stress response that the brain still wants to suppress with using.  Addicts can have hundreds, even thousands, of triggers.  It takes time to identify these triggers because they can be as subtle as seeing someone eat cereal with a spoon.  Identifying and properly dealing with these triggers take time, as you can imagine.

The relapse happens when an addict is triggered, and the thought process that once led to using is not averted.  The further this thought process is allowed to go, the closer the addict will get to slipping up.  This is why cognitive and behavioral change is so important, because the whole idea is to get in touch with one’s feelings, what causes them, and how to deal with them in a healthy way.  It is safe to say that those in early recovery are at higher risk than those with more time, however you still hear about people relapsing after 15 years of abstinence.  Unfortunately, sometimes those addicts in early sobriety get hit with heavy emotional triggers that they are not equipped to handle.  I can attest to this first hand.

The first time I got clean, I was in treatment for 10 days and remained clean for another month.  I felt confident.  Then I got a phone call from my friend Lou who told me that my best friend Ryan was dying of Leukemia.  (Ryan had been in remission for a year.)   Because of my experience working with the American Cancer Society, I already knew how bad it was.  Leukemia has a track record of coming back with a vengeance.  Ryan died while I was on the phone with Lou.  I had no time to prepare for this, and I used for the first time since treatment at his funeral.  In the bathroom.  Looking back, I see that my relapse happened on that phone call, when I didn’t take action to get help and instead I let my brain go down the usual path.  This is an extreme example of a trigger; they can be much less obvious yet still kickstart the same thought processes.  (The aforementioned cereal spoon, for example, would trigger any IV heroin addict early in sobriety.)

How should I approach my loved one?

Ultimately, the responsibility to stay clean and sober is on your loved one.  You cannot prevent a relapse, but you CAN take notice when something seems to have triggered them.  If you sense something has triggered a loved one, it’s okay to approach them.  Just do it in a way that isn’t accusing or combative.  Encourage them to seek help or call their therapist.  It’s even okay to go to a meeting with them or invite them to your yoga studio for some relaxation yoga.  But it’s not your responsibility to lock them out of their life, or insert yourself where you’re not invited – which could seem like a valid solution to some.

It is natural to feel frustrated, even angry when a loved one goes out.  “You were doing so well, why would you throw it all away?” is a common response.  “How could you?” is another one.  “I’m done with you.” unfortunately, is also very common.  To the addict, these responses are adding insult to injury.  And although they come from a place of love, it feels quite the opposite.  They are asking themselves the same exact questions, and likely are as – or more – disappointed as you.

Instead of vocalizing your anger – which you are justified in feeling – take a moment to gather yourself.  Be gentle.  On both of you.  It is easy to regress back into the state of mind that your loved one lacks will power, or doesn’t care enough.  A mentor of mine says “try drinking a bottle of Ex-Lax, and will yourself to not use the bathroom.  That’s how much willpower has to do with using.”

The most productive response, no matter how difficult, is to be supportive.  If your loved one needs anything, it is the knowledge that you are there for them and that you haven’t given up hope.  No doubt they feel shame beyond comprehension – guilt for putting you (and them) through this again – so it is also important for them to know that you are taking steps to take care of yourself.  Seek therapy, go to Al-Anon meetings, meditate or pray.  Build your own support group of like-minded peers who have been through this before. They DO exist!

But, there are things that you can do that are helpful.  So, again, if someone you love relapses, remember these 4 things:

1)     Be gentle.

2)     Do not give up hope; it’s not the end of the world.

3)     No matter how hard we try, we don’t get everything right the first time.

4)     Take steps to get support for yourself.

If you or a loved one is currently struggling with drug or alcohol addiction, I encourage you to take steps to get help.  Recovery can be very scary, but trust me, the light at the end of the tunnel is bright and there is HOPE.

Marcus Abernathy is a recovering drug addict pursuing a Master’s Degree in Clinical Psychology, specializing in Addictive Behaviors.

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