For the clinicians and medical staff who treat individuals with substance use disorders, the term relapse can hold a different connotation than the one commonly held by the average layperson and even for those within the 12 Step community. In medical terms, a relapse is defined a return to behavior in a way that an individual could be re-diagnosed with an active substance use disorder.
Relapses occur for any number of reasons after an individual tries to change their behavior and becomes sober. Many times, it can be preceded by the individual falling into similar behavior patterns or situations that triggered their drinking in the first place, but for some relapse is preceded by nothing and simply occurs for seemingly trivial reasons. Ideally, when a relapse occurs, it should not be followed by continual usage or the loss of hope. Rather, it should be recognized as a minor lapse and a reason to seek further treatment or self-correct and return to their recovery plan.
Lapses and Relapses
Individuals within the recovery and 12 Step community may hold differing views about the nature of a relapse. Some hold the distinction that there can be minor lapses wherein a person has a small slip and is able to self-correct. This is compared to a full blown relapse where the person returns to nearly every behavioral pattern that characterizes their active usage of s substance. Others hold that this scenario simply isn’t possible if someone has a substance use disorder, and that any lapse qualifies as a relapse. However, most of us can agree that an individual who experiences multiple lapses periodically followed by brief periods of abstinence is considered someone who is relapsing and would get a great benefit from seeking clinical treatment.
The Reality About Relapse Following Inpatient Alcohol Rehab
One of the most important things to understand about the nature of relapses is that they are not rare events/ Data from the National Institute on Drug Abuse shows that relapses among individuals in recovery from a substance use disorder are as common as relapses among individuals who have health disorders such as hypertension, asthma, and diabetes. The relapse rates for these and substance use disorders range from between 40 to 60 percent, with variants according to the type of health disorder and the type of substance being used.
Another reality about the nature of recovery for individuals suffering from alcohol use and substance use disorders is that relapses should not be looked on as failure to recover. Relapse is something you should aspire to always avoid, but just because it happens once does not mean you have lost the fight against addiction. Think of it more as a day to day battle. During your sobriety, you had many days where you won the fight against addiction. Just because addiction won out for a day does not mean that it has won the next day, or the day following. Recovery is about setting goals and doing your best to achieve them. For sure, it is still preferable that you reach your goals for sobriety but it is not the end of the world if you slip up. It’s a rare feat for anyone to achieve a significant goal without first going through the occasional slip up.
Individuals in recovery must learn to remain committed to recovery despite the setbacks that may occur. That is not to say that relapses should be passed off as minor. Relapses should be taken seriously by anyone who has graduated from an alcohol inpatient rehab center. The circumstances and feelings surrounding a relapse need to be analyzed and understood and shared with the individual’s treatment center. This way, instead of being freak occurrences and to avoid being blindsided by a relapse in the future, clinical providers can teach coping methods and tools for avoiding relapse down the road.
How to Avoid Alcohol Relapse Following Inpatient Rehab
One of the foremost authorities when it comes to work regarding recovery from substance use disorders is the psychologist Dr. G. Allan Marlatt. His series of books and articles have been used by clinical providers to gain insight into relapse prevention and strategies to help individuals in recovery to overcome the feelings of guilt and shame that can accompany relapse. Although targeted at clinical providers, Dr. Marlatt’s work can offer the average layperson in recovery useful tips and guidelines for navigating through a relapse. Here are some of the tips suggested by Dr. Marlatt and his colleagues.
Stay Involved in a Formal Treatment Program
Being involved in some sort of treatment program following alcohol inpatient rehab such as intensive outpatient or 12 Step meetings has been shown to reduce relapse rates and improve chances of recovery from relapses when they do occur. The foundation of any alcohol use disorder treatment is structure and support. The group format of many post treatment programs is useful for helping individuals maintain sobriety and build a support system in the case of a relapse, but seeking formal treatment in the form of therapy from a licensed therapist is also very useful.
Understand Your Triggers
Dealing with cravings and triggers following inpatient treatment for alcoholism will be vital to long term success. Developing strategies and techniques to overcome these specific instances can make the difference between relapsing and staying on the path of success. Much of the time spent in a formal treatment program will have been centered around developing these strategies and techniques, so hopefully you will be armed with the right knowledge.
Change Your Environment
Individuals who graduate from rehab for alcoholism often find that they have many changes to undertake when they return to their daily lives. In fact, they may have undergone changes while in rehab. However, the environment they came from hasn’t changed at all likely. This means that the individual in recovery must seek to make the kinds of positive changes required to ensure that their chances of relapse are reduced. This can constitute anything from finding a new friend group to learning new hobbies or moving to another state. Letting go of old friends and hangouts can be difficult but it is sometimes necessary if those relationships are unhealthy. Recovering addicts generally find comfort in becoming involved with support groups or learning new hobbies that occupy the body and brain.
“Urge Surfing” is unique term for helping recovering addicts to overcome negative thought patterns. Many people in recovery who have been sober for a decent period of time wind up fantasizing about their past alcohol use or romanticizing the fun and pleasurable aspects of using again. This is a common trap for recovering addicts who have put some distance in between their current state and their past drinking. They grow complacent and start to minimize the harm that alcohol caused them. “It’s not that bad.” “I’ve quit before, I can do it again.” These are common thoughts that alcoholics may have in recovery. Urge Surfing is a practice wherein you recognize yourself romanticizing about alcohol and you fire back by conjuring up experiences where alcohol was harmful. Remembering your darkest times should be enough to convince you not to drink again.
Stress is one of the biggest triggers for relapse. An important aspect of recovery is learning and practicing stress management techniques. Stress is a major issue for individuals in recovery, which is why many treatment programs will include cognitive behavioral techniques intended to to help with stress management, including strategies such as mindfulness meditation, progressive muscle relaxation, and diaphragmatic breathing techniques.
Address Co-Occurring Disorders
A high number of individuals who have an alcohol use disorder also have a co-occurring psychological disorder such as anxiety, depression, bipolar disorder, or PTSD. Many of these individuals may be aware of one and not the other, or they may be completely unaware of their disorders. In any case, people in recovery will not be able to remedy a substance use disorder without addressing a co-occurring disorder. Any attempts are doomed to failure. The individual must treat their disorder holistically.
Build a Strong Social Support Network
Within rehab you may have had the opportunity to bond with peers over commonalities and even find strength in sharing and supporting one another. Once you’ve graduated from treatment however, it becomes harder to constantly be surrounded by such a supportive environment. That is why seeking out support groups in your area and around is especially important. Peer support and volunteer groups can make or break someone’s recovery plan, so go out there and find a sponsor, participate regularly in support meetings, and be an open advocate for the recovery community.
Idleness and boredom can be just as killer to your recovery plan as stress. Recovering addicts may find themselves with extra time on their hands that used to go towards drinking. Now, however, they find their schedule has opened up considerably. This is where developing new hobbies can be beneficial for recovery. For example, getting involved with team sports, reading books, learning an instrument or language…these are all places to get started in replacing the time spent on addiction with time spent on something productive that makes you happy. Other ideas include: taking cooking classes, taking college courses, or volunteering.
Health and Fitness
Addiction to drugs and alcohol can wreak havoc on the balance we normally maintain when it comes to healthy diet and exercise. Maintaining a regular aerobic exercise routine can actually lower risk of developing an addiction or relapsing from a prior addiction. Research has shown that individuals who regularly engage in exercise are less like likely to use and abuse illicit drugs, and that exercise offers special protective behavioral and neurological effects against developing a substance use disorder. Regular exercise has many benefits for recovering addicts, such as: providing structure, keeping the mind/body occupied, producing healthy neurochemicals, increasing self image and mood, improving sleep quality, combating cravings, helping maintain physical health/weight, reducing stress, and improving memory.
Avoiding Triggers After Rehab
Triggers are situations or feelings that elicit cravings to use a substance again. In the case of alcoholics, triggers can be anything from receiving a piece of bad news to visiting a bar and seeing people enjoy liquor. Cravings are intense desires and urges to use again, despite the possibility of inflicting serious harm. Cravings can be easy to identify but difficult to overcome. Alcoholics in recovery must learn to understand the situations that will be provoke them to use again and how to avoid or deal with them. It’s important to remember that:
- Feeling cravings is not a failure or sign of weakness.
- Cravings do not reflect poorly on your treatment program.
- Cravings affect all individuals in recovery.
- Learning to identify triggers and cravings will prepare you to face them in the future.
So You Suffered a Relapse. Now What?
Any time a relapse occurs, it is best to have a plan in place that you can follow without having to think about it. If you don’t have a plan in place or if this is your first relapse, here are some general steps you can take.
Step 1: Put Down the Drink
If you are at bar, party, or any environment where more drinks are available, you should leave the situation as soon as possible. Call a ride, leave the room, get yourself away from the possibility of more drinking as soon as possible. If you are drinking alone, pour the alcohol down the drain.
Step 2: Call Your Sponsor
Contact your sponsor, or if you don’t have one yet, call anyone you know who is in recovery as well or who is part of your support group and discuss the situation with them. This person will understand where you are coming from and offer advice and support for you.
Step 3: Call Your Treatment Center
Contact your treatment center and let them know that you have had a relapse. There will be no one else better prepared to help you discuss and get back on track with your recovery than the treatment center you first went to. They may advocate for re-entering treatment, but you should try and speak with your assigned therapist and counselor to discuss your options and see what they think of your situation.
Step 4: Drop the Guilt Trip
It’s natural to feel shame about your relapse, but ultimately there is no benefit to beating yourself up for going through this. If anything, your guilt and pity for yourself will only push you towards drinking more. Be objective about the situation and recognize that many addicts have relapses, and the only thing to think about should be figuring out how to move forward.
Step 5: Recommit to Your Sobriety
Sometimes we need setbacks to recognize our weaknesses and the areas where we can improve. Use this slip up as a learning opportunity for what kinds of situations trigger you to use again. Recognize all the benefits that sobriety has brought you and recommit yourself to staying on track with your sobriety. If need me, you can re enter rehab or even try committing to intensive outpatient treatment.
The important thing to remember about relapse is that it’s only a small step in your personal road to recovery. If a relapse occurs, it just means you have an opportunity to address something that may have been causing you stress or getting in the way of your sobriety. If you wish to learn more about relapse prevention strategies and techniques, visit the Landmark Recovery website. Our patients are provided with the tools, resources, and support they need to find clarity in the fight against addiction with the help of drug and alcohol rehab facilities. We provide residential treatment, outpatient treatment, and medical detox services to individuals struggling with a substance use disorder. If your or someone you love is struggling with an addiction, don’t hesitate to call our admissions team.