Why do so many drug and alcohol addicts relapse? The answers are complex

Source: https://www.theguardian.com/

December 12, 2022

It’s important for patients to know past relapses don’t define you, and ongoing help from professionals and friends is critical to recovery

The modern mind is a column where experts discuss mental health issues they are seeing in their work

Ben* has been battling a drug and alcohol addiction for more than a decade. At 32 years old, he has experienced more than the average person his age.

Ben suffered a horrific injury in a car accident when he was 21 and became dependent on painkillers. From there, he tells me in his first group therapy session in rehab that he began experimenting with a range of different drugs and drinking “whatever he could get his hands on”. Ben is known as a serial relapser. He has had two one-week stints in rehab and countless sessions with psychologists and therapists over the years to help him recover from his drug and alcohol addictions. After sharing his story, he admits to the group that this three-week rehab is his last hope.

The realities of relapse

Relapse is not uncommon when first attempting to recover from alcohol addiction and other addictions. While rates vary, it’s been estimated that between 40% and 60% of people with addiction will experience a relapse.

The most common reasons for relapse are: having unrealistic expectations of how your “new life” is going to be; trying to continue to live your life the way you used to, such as mixing with your drinking friends; and socialising at your usual places and trying not to drink, which can be extremely difficult when attempting to maintain sobriety or abstinence. Other triggers that can lead to relapse are being unaware that stopping drinking completely is the first step, and that you will have to reshape your life to accommodate your recovery. Recovery has to come first.

Many clients, like Ben, think that once they stop drinking or using, their problems will disappear. This is often referred to as the “honeymoon period”, and it will end. The truth is, rewiring the brain can take up to 90 days after abstinence, and the more intense the treatment is during those days, the more successful clients can be. Writer Johann Hari says that “the opposite of addiction is connection” and the flow-on effect of being in programs with others on the same path can greatly enhance recovery. Some clients benefit from 12-step programs, in conjunction with treatment programs which focus on their trauma and underlying issues such as depression and anxiety, post-traumatic stress disorder (PTSD) and complex PTSD.

Connection and support are key to recovery

Long-term sobriety is possible for serial relapsers if they commit to the process. It’s important that patients like Ben know past relapses don’t define you. I have had patients who have had many relapses and gone on to be sober for decades. I tell Ben that it’s not uncommon for many of us to feel overwhelmed when we’ve gone off course, but it’s important to recognise that a relapse doesn’t equal a failure. This is the time to reach out for extra help. It’s essential that a person receives ongoing care and support to break the addiction cycle in early recovery and continue on their road to sobriety. They need the tools, education and accountability to prevent potential relapses.

Addicts live lives of quiet desperation – hence the need for connection to recover

Addiction is similar to a chronic disease which requires medical and psychological intervention. However, recovery from other fatal diseases does not carry the shame that addiction does. There is always a desire to start looking great on the outside quickly, but this is a trap. Putting too much emphasis on living from the outside in, rather than the inside out, means we can miss the critical point of how we are now in this situation. Three week in-treatment programs give us time to receive information, hear and integrate psycho-education, and more importantly begin to understand the underlying causes and conditions that have played a major role in developing maladaptive behaviours.

Being in a treatment facility allowed Ben to take time away from his family, relationships and business pressures to focus on his recovery and reassess his life up to that point. Ben often talked about standing at a crossroad; after three weeks of inpatient treatment and further time in a relapse prevention program and a closed trauma program, he realised his recovery was a daily proposition. Taking time to assess where he was and more importantly what direction his life could take was paramount to him not relapsing. He also began to connect with support from others on a similar path. Professional support is necessary, but ongoing support from friends, family and others has helped enormously on his journey.

Ben’s rehab experience forced him to be honest about his addiction, as well as the impact his car accident had on his life and his beliefs about himself. Although Ben took time to settle into the program, he was able to see the value others were gaining from committing to the process. After a few days, he too allowed himself to take responsibility for his addiction and understand he was not going to be able to do this on his own. He now understands the importance of support for transitioning into his new life. This is often a critical step in recovery. Addicts are often very alone in their lives, even though they may appear gregarious. They live lives of quiet desperation – hence the need for connection to recover.

For Ben, we also implemented daily practices with a focus on self-care. Some clients attend to their needs in practical ways, for instance when they swim or go for a surf, while others connect by walking their dogs and making daily phone calls with friends or others on a similar recovery journey. These are important behavioural changes that support us to keep going and overcome difficulties that will inevitably arise during recovery.

Ben has now been sober for 18 months and is committed to his new life and recovery. He says his new life is “wonderfully full”, qualifying it as taking one day at a time. He continues to attend to his recovery by staying connected to his support groups, the treatment centre and his 12-step community.