Going to Drug Rehab Again

Addiction is a chronic disease and periods of relapse are a common feature of the illness, according to the American Society for Addiction Medicine.¹ Recovery from addiction is a long-term process, and many people experience relapse in between periods of remission.² Statistically, relapse rates for addiction are between 40–60%.³

What is Relapse?

A relapse is when you have been sober and return to using a substance consistently.^3,5 For example, a relapse for someone with substance use disorder where to use a substance, then found themselves continue using for several days.

A lapse can be defined as short-term resumption of a substance. It can be seen as less serious form of relapse; lapses don’t always lead to relapse.⁵ An example of a lapse could be if someone with substance use disorder is trying to stay sober and ends up using a substance, but after the single use they stop using and continue practicing sobriety.

Addiction, including relapse, changes how the brain works, especially the areas that control judgment, decision-making, and impulse control.³ In addition, strong cravings can be overwhelming and may lead to relapse, especially if you don’t have sufficient coping skills to manage them.³

Risks and Stages of Relapse

Relapsing can be risky or life-threatening in some cases. It can be easier to overdose during a relapse, because you may take the amount you used to take without realizing that your body cannot handle that much of the substance.³

Relapse has been identified as having 3 stages.⁶ The emotional stage is the first stage, when you aren’t thinking about drinking or taking drugs.⁶ However, your behaviors are preparing you for a relapse in the future if you don’t actively do something about them.⁶ Denial plays a big role in this stage, and some of the warning signs of this stage are:⁶

• Focusing your attention on other people’s issues rather than working on your own.
• Isolating from friends or family.
• Skipping self-help meetings or treatment sessions.
• Staying quiet in meetings or groups if you do go.
• Not expressing your emotions.
• Not paying attention to your eating, sleeping, and exercise habits.

In the mental stage, you’ll have conflicting feelings of wanting to use and wanting to stay sober.⁶ If you don’t work on this conflict, eventually, the desire to escape will get stronger.⁶ Some warning signs of mental relapse include:⁶

• Bargaining.
• Being dishonest, even about small things.
• Remembering people, places, and things connected to your substance use.
• Romanticizing substance use in the past or minimizing consequences you have experienced.
• Thinking of opportunities to use.
• Thinking of ways in which you can control your use.
• Urges for alcohol or drugs.
• Planning a relapse.

Physical relapse is the final stage, when someone consumes alcohol or begins using a substance.⁵ For many people, even just a small lapse can lead to not just a relapse, but also a compulsive pattern of thoughts about using that makes it difficult to stop without assistance.^4,5

Relapse Prevention

Since addiction is a widely researched field, newer and more effective techniques are always being developed and implemented, especially in the field of relapse prevention.³ If treatment didn’t work the first time, some aspect of the original treatment plan may need to be fine-tuned with new techniques.³

There are a number of relapse prevention strategies that you may encounter during rehab. For example, those experiencing relapse can learn more about potential triggers and develop effective ways to identify and manage high-risk situations, negative emotional states, and cravings and the cues that precede cravings. In addition, medications can be incorporated into treatment to help you better manage or even prevent cravings and allow you to focus on working toward a more balanced lifestyle.⁷

Many facilities will encourage you to attend self-help meetings to further your recovery goals.^3,6 Additionally, training in self-care and holistic treatment that includes: yoga, meditation, stress management, physical activity, and healthy nutrition can help you prioritize a healthy lifestyle after you leave treatment.⁶

What to Expect When Going Back to Rehab

Going back to rehab doesn’t mean you or your loved one failed. Relapse can happen for a number of reasons and going back to rehab opens the door to improve the recovery plan and take new steps towards sobriety.

Setup for success. Always discuss the recovery plan with your treatment team. Treatment plans should be tailored to a patient’s specific needs. Here are some suggestions to make recovery plans more successful this time:⁶

• Be willing to change and keep an open mind.
• Think of the strengths and weaknesses of the previous plan. Keep the strong parts and improve the weaker parts.
• Speak up during sessions. Talk about what’s going on and how you feel. You can’t get help if you don’t share.
• Listen to feedback. It’s important to share, but it’s also important to listen.
• Go to self-help meetings. It’s a great way to get support and make some friends that don’t drink or use.
• Stick to your aftercare plan. This can include private therapy sessions, sober living, or self-help meetings.

Preventing Future Relapse

Everyone in recovery struggles with the urge to use at some point. While your treatment team can help you to tailor an individualized consider these practical tips to avoid a relapse in the future:⁶

• Ask for help. You don’t have to do everything on your own, and people are willing to be there to support you emotionally as you re-enter recovery. You can ask your family and friends for support, and people in recovery tend to be very supportive of each other.
• Be honest. Addiction often involves telling lies, either to yourself or others. If you’re feeling the urge to be dishonest, you may want to take a look at what is making you want to hide the truth, since it can be a sign of emotional relapse.
• Get some sober support. Everyone needs to talk to someone, and sober support is important, especially after you’ve finished treatment. Attending self-help meetings is a good way to get this kind of support.
• Learn how to have fun without using. Since boredom can be a trigger, find a way to enjoy yourself in recovery with fun sober activities. No one wants to get sober only to feel bored all the time.
• Practice self-care. If you’re neglecting your eating habits or sleep and feeling stressed or overwhelmed, you may be more likely to relapse. Setting aside time to eat, sleep, and manage your stress is a good way to lower your risk for relapse.

Relapsing doesn’t mean failure. As long as someone that expensing a relapse recognizes the lapse, taking action, returning to rehab, and adjusting their recovery plan is key and can lead to long-term sobriety.

Sources

1. Public Policy Statement: Definition of Addiction. (n.d.). American Society of Addiction Medicine (ASAM), 1–8.
2. Drugs, Brains, and Behavior: The Science of Addiction. (2007, April). NIH Publication.
3. National Institute on Drug Abuse. (2018). Drugs, brains, and behavior: The science of addiction.
4. Narcotics Anonymous. (1986). Recovery and relapse.
5. University of California Santa Cruz. (2016). Relapse prevention.
6. Melemis, S.M. (2015). Relapse prevention and the five rules of recovery. Yale Journal of Biology and Medicine, 88, 325–332.
7. Herron, A., & Brennan, T. K. (2015). The Asam Essentials of Addiction Medicine (2nd ed.). Lippincott Williams & Wilkins, (379-381).