The American Society of Addiction Medicine (ASAM) defines as addiction as a chronic brain disease, with behavioral, biological, social, emotional, and physical aspects, that is characterized by an inability to control substance abuse.
The fact that addiction is chronic means that relapse is often part of the disease. The National Institute on Drug Abuse (NIDA) likens the relapse rates for addiction to those of other chronic and relapsing diseases, such as asthma, hypertension, and type I diabetes, estimating it to be between 40 and 60 percent. Relapse is the return to substance abuse after a length of time being drug- or alcohol-free.
Relapse is considered a common aspect of the disease of addiction and does not, therefore, indicate failure. When a person battles addiction to mind-altering substances, brain circuitry is disrupted by repeated alcohol or drug abuse. Pathways involved in how a person feels pleasure and processes rewards, impulse control, memory, and decision-making are altered through substance abuse. With repeated use, brain chemistry and these pathways are changed, and a dependency on the substance is built. Once a physical dependency is established, withdrawal symptoms and drug cravings may be common side effects if the drug is removed or stopped suddenly. Someone struggling with drug dependency may not feel “normal” without the drug’s interaction in the brain. A return to drug or alcohol use may seem like a good way to get back to what seems normal, curb withdrawal symptoms, and combat strong cravings. Relapse may then be a form of self-medication.
Dependency can be a sign of addiction, as individuals who battle addiction are often dependent on the substance being abused; however, dependency on its own does not constitute addiction. The National Survey on Drug Use and Health (NSDUH) reported that 21.5 million Americans over age 11 suffered from a substance use disorder in the year leading up to the 2014 survey.
Relapse is considered a normal part of addiction recovery and should be understood to be a stepping stone on that path and not as the end of the road. Relapse often indicates that treatment needs to be reinstated or adjusted. Relapse can vary in its intensity and duration as well, and there are several ways for a person to decrease episodes and severity of relapse through treatment programs, therapeutic methods, and a strong support system.
Certain triggers can increase the chances that a person may relapse.
Understanding what these common triggers may be can help someone to avoid or minimize relapse in response to them.
Detox focuses mainly on the physical aspect of addiction, but in order to avoid relapse, the emotional and behavioral aspects need to be considered and addressed. Cognitive Behavioral Therapy (CBT) is an effective tool for enhancing treatment and helping to reduce relapse, as the journal Psychiatric Clinics of North America states that abstinence rates may be increased with the use of CBT methods. Behavioral therapies help a person to become more self-reliant and able to work through potential stressful situations that may arise. CBT explores the way a person’s thoughts are related to actions, and the therapy can design ways to modify negative thought patterns, thus positively affecting behavior.
Stress is a common trigger for relapse. By learning ways to cope with both external and internal stressors with CBT, individuals may be able to avoid a potential relapse. Studies published in the journal Psychiatric Times have indicated that CBT may actually help to improve a person’s neurobiological circuits in the brain. Depression, anxiety, and mood fluctuations are common side effects of addiction and withdrawal, and CBT can help to smooth out some of these symptoms by teaching strategies to manage them.
Staying in treatment for the entire length of the program is important to avoid potential relapse.
This ensures that new strategies and coping mechanisms are firmly in place before being reintroduced to everyday life. Length of time in treatment has been directly correlated to continued abstinence and recovery, Psych Central reports, with those who are able to stay in treatment for longer being more likely to avoid relapse down the line. The longer a person stays in treatment, the more established new and healthy habits become, and the more the brain is able to heal.
Medications may also be useful during addiction treatment to regulate moods, manage withdrawal, and keep drug cravings to a minimum. As a result, they are often a vital part of a complete treatment program. Comprehensive substance abuse treatment programs often include both therapeutic and pharmacological methods to promote and sustain recovery while working to minimize relapse and manager use triggers.
Holistic refers to the “whole person.” Holistic treatment methods work to improve a person’s overall quality of life, including physical, spiritual, and emotional aspects of life and living. When people feel good physically, they are more able to handle things well emotionally. Balanced nutrition and healthy levels of physical activity can therefore help an individual to avoid feeling the need to turn to drugs or alcohol.
Insomnia and fatigue are typical side effects of addiction and withdrawal, and not getting enough sleep can be a potential trigger for relapse, the New York Office of Alcoholism and Substance Abuse Services (OASAS) publishes. Regular physical exertion and a balanced diet can improve a person’s sleep quality, as can setting up and sticking to a structured sleeping, eating, and exercise schedule. This can help to retrain the body to sleep better.
Exercise may serve as a preventative tool for relapse as well, as the journal Frontiers in Psychology reports that regular aerobic exercise may make it less likely for a person to use, or return to using, drugs. Not only does exercise enhance sleep, but it may also work to improve brain chemistry and circuitry. Exercise can be a healthy outlet for individuals to reduce stress and provide new ways to feel pleasure without drugs or alcohol. In addition, regular exercise can enhance a person’s physical appearance and therefore improve self-image and self-esteem.
Drugs and alcohol deplete the body of necessary nutrients and make it harder for the brain to function optimally. When people regularly abuse drugs or alcohol, they are likely not eating healthy, balanced meals. This lack of proper nutritional intake can cause some of the body systems, as well as a person’s mental health, to deteriorate and not function properly. By improving the balance of essential vitamins and minerals in the body with healthy eating habits, relapse can be prevented, as stress is reduced, cravings are minimized, sleep is enhanced, and brain and bodily functions are restored, Today’s Dietician publishes.
- Yoga: Breathing and stretching techniques can be practiced anywhere at any time to help manage stress, reduce possible cravings, and improve mental health.
- Mindfulness meditation: This concept teaches people to become more self-aware and therefore better able to recognize and cope with potential triggers to relapse.
- Acupuncture: This involves the use of needles by a trained professional to improve the flow of energy in the body, improving bodily functions and potentially reducing cravings.
- Massage therapy: Touch is used to enhance blood flow and improve physical body systems, which can then enhance mental functions.
Holistic and complementary methods help to reduce relapse by taking a whole-person approach. As a result, these methods can be very helpful in addiction treatment and long-term recovery.
The Environmental Aspect of Recovery
The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that approximately 8.9 million American adults (aged 12 and older) suffer from both a substance use disorder and a mental health disorder of some type.
Underlying medical or mental health conditions can be a potential relapse trigger. By working to treat both disorders, recovery may be sustained. Integrated treatment models that treat co-occurring disorders simultaneously are ideal in helping to manage both disorders and therefore foster a long-term recovery for both issues. Drugs and alcohol may seem to provide temporary relief for mental illness symptoms; however, in actuality, substance abuse interferes with treatment for mental illness and ultimately makes symptoms worse. By treating both disorders at the same time, symptoms can be improved and relapse may be avoided.
Tips for Preventing and Minimizing Relapse
A relapse after completing treatment does not mean that treatment failed or even that a return to intensive treatment is absolutely necessary. It does, however, signify that a return to some form of treatment is needed. If relapse occurs, steps should be taken to reduce the severity and duration of the relapse episode. Often, a different treatment model or method may be advisable to keep the relapse event from continuing or advancing. Recognizing that stress is a common relapse trigger, and learning how to manage and recognize potential stressors and keep moods regulated, can help.
Below are some helpful hints for reducing or avoiding relapse:
- Get enough sleep.
- Eat a balanced diet low in refined sugar and high in protein and complex carbohydrates.
- Exercise regularly.
- Consider holistic methods for managing stress naturally, like yoga and meditation.
- Avoid caffeine.
- Attend all therapy and counseling sessions.
- Join a support group and attend meetings regularly.
- Take any prescribed medications or supplements as directed.
- Undergo a complete medical and psychological assessment to ensure any co-occurring disorders are also managed.
- Avoid people, places, or things that are tied to previous drug or alcohol use.
- Surround yourself with positive and supportive people.
- Take up a creative endeavor, like painting, sculpting, writing, dancing, or playing an instrument.
- Be self-reliant and try not to expect too much from others.
- Keep the mind occupied.
- Ask for help when needed.