Relapse is the recurrence of a prior condition, usually representing a negative connotation such as the return of an illness after a period of improvement, or also, in the context of substance abuse, the re-initiation of drug-seeking behaviors and the resumption of use after a period of abstinence.
Like many other chronic illnesses, addiction is a chronic, relapsing, brain disease that, while treatable, is almost never cured. Even when drugs are unavailable for long periods or when users are successful in curbing their drug use for extended periods, individuals remain vulnerable to events that precipitate relapse.
What Causes Relapse?
Some people can detox from a substance and have little difficulty in remaining abstinent as they resume a healthy and positive lifestyle, while others are at a high risk of relapse due to age, genetics, underlying health conditions, and lack of environmental or social support. The primary triggers for relapse are re-exposure to the drug, environments, people, and things associated with substance use, cravings, stress, and lasting physiological changes to brain systems that mediate the effects of these triggers.
Relapse vulnerabilities will remain indefinitely without vigilant efforts to identify the internal and external influences that need to be addressed and minimized on a daily basis. Although abstinence is essential to relapse prevention, it is not the only issue. Recovery can be achieved only when patients change their attitudes and behaviors that led to and or were associated with drug use.”
Relapse and Mental Health
Million of adolescents and adults are affected by co-occurring mental health disorders that were either caused by the substance abuse or were underlying causes of it leading to long-term relapse vulnerabilities. An estimated 43.8 million adults had a past year any mental illness (AMI); 10 million adults had a serious mental illness (SMI) and 2.6 million adolescents had a major depressive episode (MDE). Nearly 359, 000 adolescents had a co-occurring (SUD) with MDE, 7.7 million adults had co-occurring SUD and AMI, and 2.3 million adults had co-occurring SUD and SMI.
Any substance that has the ability to make you “high” or feel pleasurable senses interplays with the reward centers of the brain and dopamine neuro-transmissions that become deregulated over time, decreasing the ability to feel good naturally and inhibiting the controls of brain stress systems Addiction changes the brain in fundamental ways, disturbing a person’s normal hierarchy of needs and desires and substituting new priorities connected with procuring and using the drug. The resulting compulsive behaviors that weaken the ability to control impulses, despite the negative consequences, are similar to hallmarks of other mental illnesses.
The alterations in the physical structure and physiological functioning of the brain from exposure to psychoactive substances increases the person’s susceptibility to anxiety, depression, stress, negativity, mood swings, sleep disorders, behavioral disorders, cognitive disorders, and suicidal or violent tendencies. The impacting harm that this has on the abuser as well as others creates an atmosphere of mistrust, neglect, fear, shame, or guilt that breaks down social functioning capabilities, exacerbates cravings, and adds to the despair of the addiction and the difficulties in trying to remain abstinent.
Strengths and weaknesses are unique to each individual, playing an important role in causing and preventing relapse, but, most of these areas are blurred or undefined in substance abusers because the substances change or mask the underlying truth of those conditions. Substance abuse treatments go beyond helping the person to detox in a safe and controlled manner to providing the counseling, guidance, and psychosocial support necessary to improve and rebuild the lives of those with a substance abuse disorder (SUD).
Relapse prevention is incorporated in the majority of substance abuse treatments as an integrated approach to reduce the “revolving door” phenomenon that prevails in substance abuse populations. Patients must learn: (1) that relapse begins long before drug use occurs, (2) to anticipate high-risk situations, and (3) to develop alternative coping skills to manage the stress and frustration of daily life.
Warning Signs of Relapse
Warning signs of relapse may be:
- Denying vulnerability to relapse, thinking you are cured of the addiction and letting down your guard. (It only takes one more dose to get back into the addiction cycle no matter how far or how long you have progressed in your recovery and abstinence.)
- Making excuses for resuming use such as reasoning with yourself or others for your need of the substance and using defense or denial mechanisms when thoughts or behaviors point toward impending relapse.
- Becoming complacent or non-compliant in efforts to maintain abstinence such as not going to 12-Step recovery meetings or participating in treatment.
- Idealizing substance abuse effects or past experiences and selectively disregarding the consequences.
- Neglecting physical, psychological, spiritual, or emotional health problems.
- Boredom and isolation, not engaging in healthy or productive relationships or activities.
- Entering high-risk situations such as renewing friendships with other substance abusers or staying in environments where reminders of substance abuse are unavoidable.
- Replacing abuse of one substance with another
- Overreacting to cravings, emotional distress, or relapse when it occurs (by some estimates relapse occurs in up to 90% of recovering individual and should not be viewed as a failure, but rather, as a learning event to prevent future occurrences or to signify a renewed need for treatment.)