Relapse Warnings Signs: Know What to Look for
Relapse is common in drug addiction treatment and recovery, and one of the primary foci in recovery is to help patients avoid the problem at all costs. Unfortunately, the cravings for drugs and alcohol or the feeling of being high can be difficult to combat, and when people routinely turn to their drug of choice when stressed out or dealing with other uncomfortable emotions, it can be difficult to avoid that habit when those same stressors arise in recovery.
Some patients move closer to relapse by justifying the act. They tell themselves, “I can do it just once,” “One drink won’t hurt,” or “Marijuana wasn’t even my drug of choice,” in order to make it feel like less of a risk.
Unfortunately, there’s no such thing as a good reason to drink or use drugs in recovery. There are a number of risks that a patient takes each time he picks up, including:
- Overdose. After a period of sobriety, the patient’s tolerance for drugs of all kinds is significantly altered. Though he may have required a high dose of a certain drug in order to achieve a high during active addiction, that requirement was essentially “reset” in recovery. Unfortunately, many patients don’t realize this and take what was once a “normal” dose of their drug of choice. Under current conditions, that dose is far too much to handle. Many end up overdosing in this situation; some die as a result.
- Return to addiction. Once is rarely enough. For some, it is a rapid return to full-blown addiction. One drink or use of a drug turns into a binge, and then the binge doesn’t end. For others, it’s much slower – a drink here, a joint there. Over time, the periods in between these relapses gets smaller and smaller until addiction develops.
- Loss of progress. Even if relapse is only occasional, it can mean a loss of progress in recovery. All that was earned through hard work and perseverance can begin to lose traction, throwing the patient off course.
- Return of health problems. When actively abusing drugs and alcohol, people often develop chronic illnesses. When they stop using, the progression of these illnesses is often reversed or slowed. Relapse, however, can trigger a return of symptoms.
What Is Relapse?
Different people define relapse differently. Some call it a “relapse” when any amount of alcohol or drugs is ingested for any purpose with or without intent. Therefore, to some, for example, inadvertently taking a sip of alcohol believing it to be a non-alcoholic beverage might be defined as a relapse.
Some say that taking medication that can be addictive (e.g., prescription painkillers) even when prescribed by a doctor for the treatment of an illness is a relapse. In fact, some people in recovery define the taking of ongoing medications like methadone for the purposes of detox and opiate addiction treatment as not living a clean and sober life.
Why would anyone take such a strict view of drug and alcohol use? Their argument is that after a period of abstinence, even having a small amount accidentally or for a legitimate purpose, any use of an illicit substance can rekindle cravings and be the first step down the path to a return to addiction.
However, in most cases, the generally accepted opinion is that a true relapse falls into two categories:
- A “slip.” This occurs when someone chooses to take a small amount of an illicit substance and then stops. For example, they may opt to take part in a toast at a wedding using an alcoholic beverage or take a drag off a joint that is passed their way. In these cases, it is only defined as a “slip” when it happens one time in a small amount, does not lead to the person getting high, and is immediately followed up by honesty on the part of the patient as they therapeutically address the whys of how it occurred in order to protect against it happening again.
- Relapse. A relapse occurs when a patient makes the purposeful choice to take a drug or drink in order to get high or drunk. This may be a one session event or a binge that takes place over a few days. Should the patient return to treatment services and sobriety immediately after, it is termed a relapse. If they do not, it is a relapse that triggered a return to full-blown addiction.
Why Do People Relapse?
People relapse for a number of reasons. In general, an uncomfortable emotion, a situation, or a person comes along that makes them want to get high or drunk and the craving is too strong to ignore. These events or feelings are called “triggers,” and part of most rehabilitation is focused on helping the patient to identify personal triggers and developing a plan that will allow them to avoid these issues entirely and handle them without drinking or getting high if they are unavoidable.
For many patients, common triggers can include:
- Seeing people they used to use drugs or drink with
- Going to places where they used to get high or drink
- Watching people on TV or in a movie use drugs or alcohol
- Hearing someone talk about drinking or using drugs explicitly or in positive terms
- Experiencing a difficult event (e.g., a breakup, job loss, loss of a family member, argument with someone)
- Experiencing extreme emotions that are uncomfortable (e.g., stress, anger, fear, frustration)
What Are the Warning Signs of Relapse?
In retrospect, it is often easy to identify how a relapse occurred. A patient can benefit from working with their personal therapist to backtrack and see how they went from moving forward happily in recovery to finding themselves with a drink or drug in hand.
However, though the signs can be different for different people, in general, there are a number of signs that a relapse may be an issue in the not-so-distant future. These warning signs of relapse can include:
- Fantasizing about drugs and alcohol. Touting the so-called positive effects of drinking and using drugs can be an indicator that the patient is not completely focused on the positive aspects of recovery. It’s not uncommon for the challenges of ongoing treatment to make the escape of substance abuse seem more romantic than deadly.
- Waxing nostalgic about time spent in active addiction. In the same way, glorifying behaviors and consequences of living a life of addiction can be an indicator that the patient is bored in recovery and craving the lifestyle of addiction as much as, if not more so than, the act of drug and alcohol abuse itself.
- Spending time around people who drink or get high. In recovery, it is recommended that patients build a strong support system made up of people who are also sober or supportive enough of their sobriety to remain abstinent when in their presence. It’s not easy, however, to make new friends within these parameters and, in some cases, patients may choose to spend time in places that are comfortable and where drug and alcohol abuse often occur or with people who actively abuse drugs and alcohol.
- Missing treatment sessions and therapy sessions in recovery. Regularly missing 12-step meetings, sessions with a personal therapist or group therapy sessions, and cutting out different types of therapy from their weekly schedule can all be signs that a patient’s focus is shifting from recovery to other aspects of their life and that their sobriety may be at risk.
- Justification of moderate use of alcohol. When a patients starts to explore whether or not it’s possible for them to use alcohol or other drugs in moderation or justifies use of a substance because it was not their drug of choice during active addiction, it’s a clear sign that they are taking a step closer to getting high or drinking again.
- Aggressively pushing others to choose sobriety. Conversely, it can also be a sign of potential relapse when a patient in recovery begins to target those who drink moderately and try to convince them that they need live an abstinent life or becomes highly critical of the choices made by others in recovery.
- Engaging in compulsive or impulsive behavior. Rather than sticking to a steady schedule that is full of positive activities like work and/or school, attending meetings and appointments in recovery, and focusing on their own health and well-being, a patient courting relapse may begin to focus intensely on one area of their life (e.g., a relationship, work, etc.) to the exclusion of all else.
- Spending large amounts of time in isolation. Being alone often can make it difficult for a patient to make positive connections in recovery. Additionally, it can increase the chances that they will justify the use of drugs and alcohol in some amount and decrease their accountability for their choices.
- Experience of or increase in mental health symptoms. Exhibiting higher and higher amounts of depression, anxiety, anger, loneliness, lethargy, general dissatisfaction with themselves or their life, hopelessness and other negative mental health symptoms can make drugs and alcohol look like a welcome escape and less of a threat. Especially when combined with other signs of relapse – taking time off from going to treatment, feeling nostalgic about drugs and alcohol, considering the option of moderate use of substances – it can be one of the strongest triggers for relapse.
Can You Help Your Loved One Avoid Relapse?
Family members can play an active role in helping their loved one to avoid relapse in recovery. Intervening when a sign of possible relapse becomes an issue can help them to get back on track before they actually drink or use drugs.
Some recommendations for family members hoping to help their loved one in recovery to ward off relapse include:
- Checking in regularly. If you don’t live with your loved one in recovery, make an effort to check in with them regularly face to face. Make sure that they’re doing as well as they say they are and have long enough conversations to get a full picture of what’s happening in their life.
- Speaking up. If you see any of the warning signs of relapse, don’t be afraid to speak up. Address the particular sign specifically rather than the overall fear of relapse and ask if they need any help.
- Avoiding nagging. If your loved one refuses help or seems to be moving closer to relapse rather than farther away, don’t nag. Instead, keep in touch and be ready to assist if asked.
- Remaining encouraging. Stay positive. Even if your concerns continue to grow, don’t grow too anxious, angry or scared. Focus on the positive and help your loved one to move through the difficulty naturally.
- Offering different recovery or treatment options. If your loved one is spending less time in treatment or struggling despite a full recovery schedule, suggest a new type of therapy or a change to their program that might interest them.
- Going to treatment sessions or meetings together. Take an active role in your loved one’s recovery when possible. Offer to go to 12-step meetings with them or holistic treatments and show your support.
- Attending family therapy sessions together. Family therapy sessions give you both a place to talk about your concerns, work on your relationship, and work on your ability to communicate. You may be able to discuss your concerns about relapse in this safe environment more effectively due to the professional guidance of the therapist.
- Finding a support group. There are a number of therapeutic support options for family members of addicts and alcoholics. Twelve-step groups and personal therapy are two of the most effective options, providing you with a support network as well as one-on-one assistance with issues and obstacles as they arise.
Returning to Treatment
In some cases, in order to prevent relapse or in order to prevent multiple relapses, it may be helpful to increase the intensity of professional addiction treatment services. Additionally, if recovery is not started at an intensive rehabilitation program, it is recommended that patients head back to the beginning and build a solid foundation for themselves in recovery. Learn more about how we can help your loved one strengthen their recovery here at Alta Mira today. Call now.