Many people considering recovery find the threat of relapse with substance use disorder to be discouragingly high, but those who have entered treatment and recovery know that relapse is often a part of the process. The idea of “being sober” to some is seen on a black and white spectrum, with relapse being the ultimate failure. That kind of mentality can hinder progress considerably, and induce crippling levels of guilt on people who have been working hard to achieve long-lasting recovery. That’s why innovative and effective treatment and recovery programs acknowledge that relapse is not a dirty word, and needs to be treated as part of the illness of addiction.
The relapse rate with addiction can be as high as 40-60%, much like the recurrence of other diseases like auto-immune disorders or type-2 diabetes. This is why it’s vital to treat substance use disorder as a disease rather than a “lifestyle choice” that places blame on those affected. With opioid use disorder’s relapse rates as high as 60-90%, relapse prevention and harm reduction are at the forefront of helping patients overcome and move past them.
When Relapse Happens
Once you’ve relapsed, the prevention steps you learned through substance use counseling were unable to be avoided, and you may find yourself feeling guilt or shame, having felt like you’ve thrown all of your hard work in treatment away, but there’s hope. Managing your relapse is possible. It doesn’t mean you’ve set yourself back from all the progress you’ve made; it doesn’t erase everything you’ve done thus far.
One tool that can prevent further relapse is medication. Decades of research and success behind methadone have proven it to be a very powerful and effective treatment for opioid use disorder, specifically for people who struggle with frequent relapse. Methadone maintenance can help you manage withdrawal symptoms, especially after relapse, and prevent you from using again. It also dramatically helps reduce cravings, making it easier to focus on your rehabilitation without the thought of using again hanging over your head.
There are other medications that can help this process along, including buprenorphine, often known by the brand name Suboxone®. This medication is different from methadone, but works very similarly. They both stimulate receptors in the brain which reduces cravings and withdrawals without providing the euphoric feeling from illicit or misuse of opioid drugs. Suboxone® contains both buprenorphine and naltrexone. In addition to the management of symptoms, the naltrexone is a deterrent to misuse because if injected, it causes immediate, often severe withdrawal symptoms.
Deciding which medication to take will be a personal choice that is discussed with your provider and substance use counselor. These medications, however, are not just a “replacement” for drugs, despite many misconceptions that exist due to stigma. Substance use disorder is a disease that can affect some people their whole lives and must be managed just like any other illness. In terms of relapse prevention, these medications can make it possible for people to live long, fulfilling lives without having to struggle on their own.
Relapse is not a Failure
The concept of “staying clean” is an outdated mentality in modern-day addiction treatment. The concept pushes the idea that those who relapse or return to drug use are “dirty,” which is derogatory and discouraging. Those who are managing their substance use disorder will benefit from understanding and coming to terms with the fact that relapse is a challenge they will have to battle long term, but with the help of medication, relapse prevention, and aftercare, it’s not the end-all-be-all of their success in recovery.
Relapse can provide a learning experience, whether it’s your first time or your tenth time around. Recovery is a life-long journey. It’s not like attending school and graduating after four years with a diploma. It’s a lifestyle that will need to be managed and worked for consistently. For some people, this eventually becomes effortless, but even those who make it seem easy had to go through the ups and downs of dealing with relapse and setbacks too. The key, however, is that they gained knowledge from those experiences and moved forward into recovery with what they learned.
Dealing with your relapse can be difficult, especially the first time around. After a long stretch of successfully being committed to your treatment and recovery journey, your spirits high and progress feels invigorating, making relapse feel all the more devastating. The obstacles you will overcome in dealing with relapse will make you grow stronger along the way. Overcoming the shame, guilt, and rebuilding process can instill tools in your recovery survival kit that otherwise may have never been learned.
A Different Perspective
In the past, people have looked at addiction as a weakness or someone’s inability to stop a certain behavior. Some people still go as far as to think that addiction is purely an active choice of making bad decisions, despite unequivocal scientific evidence that drugs change the way the brain works, making some substances more addictive than others. With opioids, the scientific basis of addiction is undeniable. Opioids literally change the way the mind functions entirely, not just form a behavioral standpoint. The chronic disease of addiction alters the receptors in the brain’s “reward center,” making people with substance use disorder perceive even simple things in life much differently.
Relapse should be considered as a symptom of the disease of addiction. Just like those who suffer from ailments like cancer, substance use disorder needs to be screened and maintained regularly. Those who successfully treat cancer know that there is always a possibility that it can come back, and they take steps to manage that prospect. Addiction is very similar in that aspect. Would it be reasonable to shame someone who had to return to chemotherapy after years of their cancer being in remission? Those in recovery who experience relapse should be seen in the same regard. Relapse isn’t a failure that should be shamed; it’s an unfortunate and disheartening part of managing the disease.
Relapse is different for everyone. Some have a momentary slip and correct the situation immediately, while some have a more prolonged experience. The most important thing to remember is to not give up on recovery, no matter how disheartened you may feel. While relapse certainly isn’t encouraged in recovery, the learning experience can provide some transformational opportunities for improvement.
New triggers: During your treatment drug use counseling, you may have put together your own list of potential relapse triggers. Those were the most obvious, but triggers can be insidious and unexpected. Using your relapse experience to identify what pushed you back into drug use can be immensely useful to move forward in recovery. People in recovery can’t live in a bubble, however, and sometimes bad things can happen to them or around them that can push them beyond their abilities to cope. If you’ve found yourself in that type of situation, you realize now that dealing with the stress of those kinds of situations is something you will have to work on for the future. Mapping out better coping habits using those experiences can help stop relapse in its tracks.
Regrouping: Sometimes, recovery can get very comfortable. You’ve attended all your sessions, you’ve been to counseling and support groups, and you feel like you’ve really got this recovery thing down. When a relapse throws you for a loop, you may realize that you haven’t been as dedicated as you should, or you relaxed too much with your support system. This is the point where many people start to realize how important it is to keep up with their recovery maintenance. Having a relapse prevention program is very important for long-term recovery, and sometimes it takes a slip up to understand that fully. Luckily, many treatment programs offer ongoing relapse education and support to ensure patients can continually work on themselves.
Reenergize: Relapse is never a good thing, but the way you handle it can be crucial to your future recovery. You will be questioning your commitment to the treatment and recovery process, as it’s a natural part of a setback. Using your experience with relapse is an opportunity to recommit to everything you set out to do to manage substance use disorder. Use your relapse experience to remind yourself why you chose to get help in the first place and return to that mindset by using the tools available to you. There is no shame in reaching out to your treatment facility to get the help you need, that’s what they are there for. There are options after relapse, even monitored detox for those who wish to go that route. There is a way to get back on track; you don’t have to punish yourself for relapsing forever.
Recovery isn’t just a conceptual level you reach after striving or completing specific steps. It’s a way of being. Every day you wake up, you remind yourself that all of your actions for the next 24 hours are aligned with your recovery goals. Whether you’re enrolled in treatment or are attempting to achieve recovery on your own, relapse is a very real possibility that is important to understand and prepare for. Despite the demoralizing feelings that come with such a setback, having a plan in place to get back on the road to recovery is essential. Think of relapse as a hold button, not the cancel button. You can hit the resume button on your recovery after it happens using your support system and with the help of addiction professionals who have your best interest in mind, but most of all, with your strength to fight substance use disorder and reclaim your life.