Take Another Look at Relapse

Dr. Marvin D. Seppala, Medical Director, CEO
Beyond Addictions

I attended Beyond Addiction’s graduation ceremony over the Holidays and witnessed the beauty, gratitude and hope of new-found recovery from addiction. What struck me was that the graduates had each relapsed during their involvement in treatment, but continued to finish. They all spoke of the relapses and how they were afraid to discuss them, but found that our staff accepted their situation, developed new treatment plans, and helped them to move forward with more structure. The graduates repeated that they were ashamed and feared being kicked out of treatment, but found acceptance and caring, allowing them to quickly come to understand their addiction better and continue down the path of recovery.

Relapse happens with all chronic illness, not just addiction, and the rate of relapse is basically the same whether one has addiction, hypertension, asthma or diabetes; at least
40-60% in the first year. Most relapses occur in the first 12 to 18 months of initiation of abstinence from alcohol and drugs. If we take this information seriously and work to limit relapse while accepting it as inevitable in up to half of our clients, we can greatly inhibit the negative consequences of a return to drug or alcohol use.

People relapse for a lot of reasons, but addiction research tells us the three most common reasons are: increased stress, triggers of past drug or alcohol use, and use of a small amount of a drug or alcohol (the first drink). Many people will describe their relapses as related to a lack of recognition of the seriousness of addiction, basically related to denial of the power this disease has over them. 12 Step wisdom reveals that people relapse when they quit working a program and isolate themselves. People often think that their addiction is not that bad or they are somehow different and readily able to remain abstinent, only to find out it really is as difficult as they were told.

We know from research that completion of treatment, longer treatment and follow-through with treatment recommendations results in less relapse. Addressing other problematic life stresses and issues, like a failing marriage or an anxiety disorder, helps to eliminate relapse. The research on 12 Step programs also reveals that attending meetings regularly and getting involved in recovery activities eliminates relapse. There are new medications that can be used as pharmacological interventions and help improve the percent of people who stay sober and do not relapse.

Although we always treat people with the goal of abstinence, we must accept relapse as an integral aspect of any chronic illness and inherent to recovery from addiction. We cannot shame and berate people into recovery; they need our love, our support and our best efforts using every treatment approach available to them. Relapse goes with the territory, and we need to approach it as just another feature of addictive disease and its treatment.