Chronic Relapse

Chronic relapse is frustrating, painful, and can be dangerous. It occurs when someone is treated for drug or alcohol addiction but uses again after being sober for a period of time. Because addiction is considered a chronic illness, relapse is common. However, it can be treated and prevented with long-term, individualized treatment that combines therapy, support groups, support from family, and treatment for other conditions. Managing chronic relapse also requires lifestyle changes and avoiding triggers.

Relapse for people in recovery from addiction is very common. About half of all people treated for addiction will relapse, often more than once. Relapses can be useful, in that they help a person realize that sticking with ongoing treatment is important or help identify triggers to be avoided. But chronic relapse disease is very serious and can have a devastating impact on a person’s life. It can last for years or even decades, causing a cycle of chronic relapse, addiction, treatment, recovery, and back to the beginning again.

The best way to prevent, treat, and manage chronic relapse is to start with a solid foundation of consistent and individualized long-term treatment for addiction. The first 90 days of recovery are when most people relapse, so staying in a residential treatment center for that period is a good way to manage and prevent relapse. Ongoing care and lifestyle changes, including avoiding triggers, is important after a residential stay to remain in recovery and avoid relapse.

Addiction Is a Chronic Illness

Having a relapse is frustrating, and it can be dangerous too. Relapsing multiple times is even more frustrating, but it is important to understand that relapse is not a moral failure on the part of the person struggling with addiction. Through research, experts now largely agree that addiction is a chronic illness. Relapses can be managed and prevented, but they are also very common and expected.

The relapse rates for addiction are very similar to those of other chronic illnesses. For example, relapse rates for diabetes, high blood pressure, and asthma are 30 to 50 percent, 50 to 70 percent, and 50 to 70 percent, respectively. Relapse rates for drug addiction are 40 to 60 percent. Even when treated, chronic illnesses of all types cause relapses. The idea that addiction is a chronic illness has been proven time and again, and it was in 2016 that the U.S. Surgeon General announced it as fact. He called for drug addiction to be treated as a chronic illness.

The Cycle of Chronic Relapse

Addiction causes changes in the brain that ultimately make it very difficult to stop using drugs and alcohol and that cause relapses after treatment. Addiction begins when the drug used causes the brain to be flooded with chemicals that make the user feel good. This is like a reward that may lead the person to use again in order to get that pleasure sensation. Over time, this overstimulation in the brain leads to serious changes in the brain that impact the ability to feel pleasure, impulse control, memory, and other functions.

A relapse is typically caused by a trigger—some cue in the environment—that acts in the brain of a recovering addict to begin cravings. The brain learned at some point in time that these triggers were like rewards. A trigger could be a person that the user got high with often, a place where they used drugs, or a favorite bar. The triggers remind the brain that these things in the past led to that pleasure sensation. Changes in the brain caused by drugs or alcohol have essentially rewired it to associate these triggers with substance use. Triggers cause a cycle of chronic relapse that can be difficult to combat.

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Chronic Relapse Treatment

A relapse may be treated in different ways depending on the needs of the individual. For some people, a relapse may be minor and short-lived and may come after long-term, intensive residential treatment. This type of addiction patient may only need to go to extra support group meetings or additional sessions with a counselor to overcome the relapse and get back on track.

For other people in recovery, a relapse may be more severe, causing more damage and requiring greater intervention to overcome. In some cases, a patient may benefit from going back to the beginning of treatment, getting readmitted to a treatment facility, and going through detox and treatment a second or third time. As with a first time in treatment, this relapse treatment will likely involve one-on-one therapy, group support, and alternative therapies. It will also include taking lessons from the relapse, working with therapists to understand what happened, and learning what the patient can do differently in the future to avoid a similar situation.

Chronic Relapse Prevention

The best prevention for relapse is to get good, long-term treatment for addiction and any underlying or co-occurring disorders that contribute to the addiction. Simply stopping use of a drug and detoxing is not adequate and will lead to relapse in nearly 100 percent of cases. Reducing and preventing relapse must begin with thorough and consistent treatment that is proven effective.

Research into addiction treatment has found that there are several factors needed for it to be effective, and effective is defined as having minimal relapses. These include making treatment plans individualized, addressing multiple needs of a patient, like underlying mental illnesses, and staying in treatment for at least three months, or 90 days.

This last factor is proven to be crucial for avoiding relapses. Staying in treatment for a minimum of three months has been proven to give patients the best outcomes, including avoiding relapses. Many patients end up leaving treatment early, but sticking with the program gives them the best possible chances at recovery.

A very important part of treatment that helps to prevent relapse is learning about triggers and how to avoid or manage them. Therapy sessions help patients identify their triggers, learn strategies for avoiding them, and also learn mechanisms for coping with triggers that cannot always be avoided. For instance, stress may be a trigger but can’t be eliminated, so treatment can include learning strategies for healthy stress management to reduce the urge to relapse. This kind of relapse prevention therapy is an important part of cognitive behavioral therapy that is often used to treat addiction.

Medications to Prevent Relapse

Depending on the substance of abuse, there may be medications that can help prevent relapse. For instance, there are drugs that can reduce cravings for opioids and even block the effects of opioids like heroin. Alcohol cravings can also be managed with certain drugs. While older philosophies of treatment avoided using any kind of drugs for treating addiction, experts today know from research that medications can actually help. With fewer cravings or with the effects of a drug blocked, relapsing becomes less likely.

Self-Care and Ongoing Treatment to Prevent Relapse

A chronic relapse disorder or cycle can be tough to break and using all tools at one’s disposal is important. This means adding ongoing treatment, lifestyle changes, and self-care. If a patient goes back to his or her lifestyle as it was before treatment, there may be many triggers that lead to relapse. Making positive changes, such as eating better, getting regular exercise, and socializing with sober friends can make a big difference in preventing relapses.

In addition to making these changes and making self-care a priority, most patients in recovery can also benefit from ongoing treatment to avoid relapse. This may include regular attendance at support group meetings, but it also may mean keeping up with regular therapy sessions. Maintaining that link with a therapist can be an important way to manage stress, learn and continue practicing healthy coping mechanisms, and make the kinds of behavioral changes that are important for staying sober.

Relapse is Not Failure

When it comes to chronic relapse, alcoholism and drug addiction need to be treated as chronic illnesses. It is easy to view relapse as a failure, but it is not. It is simply a recurrence of a very serious illness. This does not mean that individuals should not work hard to avoid relapses, but viewing them as failures is damaging and counterproductive. Ongoing treatment, trigger avoidance, positive lifestyle changes, and support from loved ones all help, but the most important piece of the puzzle is long-term and comprehensive residential treatment that gives an individual a solid foundation for recovery.