Many family members wonder why treatment wasn’t enough to keep their loved one on the path to recovery. After all, hasn’t he or she learned why they felt the compulsion to drink or do drugs or engage in other addictive behaviors? Didn’t they learn how to avoid the situations, people and things that trigger the urge to use again? Why is it that some individuals in recovery seem to do just fine, while others have one difficulty after another? Just why do some people relapse after treatment? And, more importantly, what can be done about it?
Each recovery has a unique path
Just as every person who has an addiction – to alcohol, drugs, multiple addictions, or addiction along with a co-occurring disorder – is unique and requires a personalized treatment plan tailored to address their particular needs, every person in recovery has a distinctive path as well. There is no one-size-fits-all route that works in all cases. How could there be when everyone’s life circumstances, personality, physical condition, mental and emotional stability are so different? Even those with similar backgrounds and the same addiction find themselves facing challenges that vary day by the minute.
What stresses an alcoholic who comes from a severely dysfunctional family background versus a cocaine addict who also has a mental health issue such as bipolar disorder may be totally different. So it is with every combination of addictions or a single addiction. Despite learning about their disease and having some experience during treatment in practicing how to recognize triggers and cope with cravings and urges, any little thing can send one person over the edge into relapse, while the next individual in recovery is able to overcome this challenge – at least for now.
Sometimes the accumulation of things that go wrong in everyday life push a person new to recovery back into addiction. In short, recovery isn’t a straight line path forward. Some stagnate in a no-growth position – neither making progress toward stated goals nor completely relapsing.
You never really know who will relapse or not. And there’s no way of predicting when someone will go back to using.
Factors that may contribute to relapse
While you can’t know for sure who will or when they will relapse, there are some factors contributing to relapse to be on the lookout for. Two of the biggest involve family and employment. Research shows that when an individual has a supportive family and is able to maintain steady employment, he or she has a better chance of a successful recovery. When one or both of these are lacking, relapse is more of a possibility.
- Lack of family support. Family support doesn’t mean carrying the individual and allowing him or her to escape responsibilities. Family support means learning about addiction and how family members can help the recovering individual with encouragement, changing family patterns of behavior, and making the home environment more conducive to sobriety. When the family is dysfunctional and doesn’t go for family treatment, or there’s other addiction present in the family, or the family members are harshly critical, judgmental and unforgiving, the result is a weak foundation for the recovering individual. He or she will find it incredibly more difficult to maintain sobriety and work toward achievement of any stated goals.
- Lack of a job or steady employment. Being self-sufficient, having a steady income, and being able to build self-esteem by fulfilling regular job duties is important to a person’s ability to maintain sobriety. Just knowing that there’s a job to go to every day is a huge plus in stability – a critical component of recovery.
Other reasons people may relapse
Below are some common reasons that people relapse. If one or two of them apply, it doesn’t necessarily mean a person will relapse. But the combination of several pressures over time can cause the person to relapse.
- Going back to the old crowd. When you’re newly in recovery, it can be dangerous to socialize with your friends who are still using. Doing so will only put you back in the same environment, subject to the same peer and internal pressures to use, and tax your fragile ability to say no to the cravings and urges to use. If your loved one starts going out with the guys (or gals) on Friday nights after work to have a few drinks – even if he or she intends to only have coffee or soft drinks or sparkling water – it’s a sure sign that trouble may be on the horizon. The temptation is too great. He or she may be able to resist once or twice, but sooner or later the invitations to join in and the mistaken belief that just one drink couldn’t possibly hurt will result in not only the first drink, but several more. Pretty soon, relapse has occurred.
- Too much stress. Everyone has stress. It’s unavoidable. But someone in recovery is particularly vulnerable to stress. They need to learn how to manage stressful situations, how to defuse daily living so that stress doesn’t mount up and become the tipping point into relapse. During treatment, your loved one learned techniques to manage stress. But learning and doing are two different things. It takes practice for these techniques to be effective. Encourage your loved one to get out the manual and practice those stress-reducing techniques so he or she doesn’t resort to alcohol or drugs as a way to eliminate stress. By the way, these techniques can work for others in the family as well. Balancing home, work and social responsibilities can be difficult. Everyone needs a little help from time to time.
- Feeling lonely and blue. It’s normal for the recovering addict to feel down in the dumps and lonely, especially in the first few days and weeks of recovery. The most critical time is the first 90 days. During this time is when the individual in recovery is most fragile and vulnerable – and most likely to relapse. Making it over this three-month hurdle is a very important accomplishment. When loneliness and depression start to take over, it may be time to encourage the person in recovery to get out and be with close friends and family members, to go to 12 step meetings and talk with his or her sponsor, and to go to see the counselor or therapist if that help is still available through the treatment program’s continuing care services. People often pick up a drink or do drugs as a way to escape their loneliness or depression. But it’s only a temporary refuge, and can be a route to relapse.
- Refusal to change behaviors. After treatment, it can’t be a resumption of the same bad behaviors that got the individual into trouble in the first place. Whether it’s alcohol or drugs or a process addiction such as gambling, compulsive sex, overwork, overspending, or an eating disorder, without a commitment to change to healthier behaviors – and actually doing them – relapse is more likely. Learning healthier behavior was also a part of the treatment program. When the person in recovery refuses to change or thinks he or she can skip this step, it makes recovery much less likely to succeed. Again, the solution to may be to attend 12 step meetings, talk with the sponsor, go back to see the counselor or therapist, or communicate honestly with family members about the need and desire to change behaviors to maintain sobriety.
- Too much availability. Family members who have gone through family treatment prior to their loved one returning home wouldn’t dream of leaving alcohol around the house. If the recovering addict either doesn’t have family at home or family members haven’t learned how the presence of alcohol or drugs in the home is an invitation to disaster for the addict, the end result is that too much availability of harmful substances spells trouble. The same thing applies to work, in the car, or any other locations where the addict stashes or uses addictive substances. In the case of gambling, proximity to casinos or the ever-present lure of Internet gaming sites is another instance of too much availability. The solution is to clean out the house, car, garage, shed, work, and other areas of all harmful substances. Driving a different way to avoid the casinos may work, as well as having the addict barred from gambling at the casino. Internet gambling is a little tougher. The recovering individual should discuss this and any other difficulty with availability with his or her counselor and 12 step sponsor.
- No motivation. Maybe the person in recovery doesn’t have any real goals or only put some down in a half-hearted attempt to satisfy the treatment therapist. Life may become a series of never-ending days of self-deprivation, a situation that seems devoid of hope and joy. Instead of looking forward to all the possibilities that a life in sobriety can bring, some individuals in recovery can’t look ahead. They’re stuck in the sameness and boredom and unpleasantness they feel today. They often think of the “good old days” when they were using, no care in the world, and may quickly find they’ve talked themselves back off the wagon. Others can’t motivate the person in recovery. That has to come from within. But going back to counseling is a step in the right direction. There’s obviously something lacking when the person who’s gone through treatment feels there’s no hope in trying for something better. Without motivation, relapse is more likely.
- Treatment ended too soon. For a variety of reasons, sometimes those in recovery have left treatment too soon. It may be that they could only afford (due to insurance restrictions on coverage or personal ability to pay) a certain length of treatment time. It could be that they completed the treatment, but it wasn’t enough for their particular situation. Some chronic addictions require longer treatment than short-term (the person has been addicted only a short while) addictions. While everyone who’s fresh out of treatment understandably feels a little overwhelmed and fearful at first, some people just really need more time in counseling to be able to handle it. If they don’t return for therapy or get some type of aftercare counseling, they may not be able to cope with the pressures, stresses, cravings and urges that assail them every day. They may resort to relapse.
- Overconfidence results in relapse. On the flip side, some individuals have a relatively easy time in recovery. Suddenly, everything is going great. They’ve returned home and everybody’s supportive. Back at work, they pick up right where they left off with no problems. Things are so terrific, in fact, that the person in recovery may begin to believe he or she is impervious to stresses and triggers and cravings and urges. Such overconfidence could very easily turn into an opportunity to relapse. Why not have drinks to celebrate a project successfully completed or smoke a joint to relax? What harm could it do? You know the answer to this one. It’s not likely to stop at one drink. The next thing the person knows, he or she may be on the wrong side of sobriety, having slipped into relapse.
Is relapse inevitable?
Not being able to predict with any accuracy who will relapse or when it will occur, the next logical question for many family members is whether relapse is inevitable. Will everyone relapse at one point or another? Should you just resign yourself to that eventuality? The answer is a resounding no.
Some 12 step groups and even counselors make a distinction between a “slip” and a “relapse.” For some in recovery, one drink may only be a slip, and they’re able to get back into their recovery program without a hitch. For others, that first drink is only the start of a major slide into total relapse. The difference is how much the person’s – and his or her family, job, social relationships – are negatively impacted. If everything slides back to where it was prior to entering treatment, it’s like starting over. He or she may very well need to go into treatment again in order to get properly grounded to be able to maintain sobriety.
The best way to approach your loved one’s recovery is to remain supportive and loving, understand what he or she is going through (to the best of your extent, based on what you learned about addiction through family therapy), be on the lookout for warning signs that your loved one may be struggling, and give it time. If your loved one does relapse, it doesn’t mean they can’t achieve sobriety again and have it last. It just means they may need more help and more practice in adopting a healthier lifestyle.
Recovery is a lifelong journey for the addict. It isn’t always a straight path. The goal is a future filled with achievement and joy.