What is Relapse?

WHAT IS RELAPSE?

Abdullah Baniyameen
baniyameen@aol.com
June 7, 2009

• Relapse is not an isolated event. Rather, it is a process of becoming unable to cope with life in sobriety. The process may lead to renewed alcohol or drug use, physical or emotional collapse, or suicide.
  
• Predictable and identifiable warning signs that begin long before a return to use mark the relapse process or collapse occurs.
  
• Relapse prevention therapy teaches people to recognize and manage these warning signs so that they can interrupt the progression early and return to the process of recovery.
  
• Studies of life-long patterns of recovery and relapse indicate that not all patients relapse.
  
• Approximately one third achieve permanent abstinence from their first serious attempt at recovery.
  
• Another third have a period of brief relapse episodes but eventually achieve long-term abstinence. An additional one third has chronic relapses that result in eventual death from chemical addiction.
  
• These statistics are consistent with the life-long recovery rates of any chronic lifestyle-related illness.
  
• About half of all relapse-prone people eventually achieve permanent abstinence. Many others lead healthier, more stable lives despite periodic relapse episodes.

CLASSIFICATION OF RECOVERY / RELAPSE:

• For the purpose of relapse prevention therapy, chemically dependent people can be categorized according to their recovery/relapse history. These categories are as follows:
  
• Recovery-Prone - Briefly / Chronically Relapse-Prone.
  
• These categories correspond with the outcome categories of continuous abstinence, brief relapse, and chronic relapse described above.
• Relapse-prone individuals can be further divided into three distinct subgroups.
  
• Transition patients fail to recognize or accept that they are suffering from chemical addiction in spite of problems from their use. This failure is usually due to the chemical disruption of the patient's ability to accurately perceive reality, or to mistaken beliefs.
  
• Un-stabilized relapse-prone patients have not been taught to identify the abstinence-based symptoms of PAW and addictive preoccupation.
  
• Treatment fails to provide these patients with the skills necessary to interrupt their disease progression and stop using alcohol and drugs. As a result, they are unable to adhere to a recovery program requiring abstinence, treatment, and lifestyle change.
  
• Stabilized relapse-prone patients recognize that they are chemically dependent, need to maintain abstinence to recover, and need to maintain an ongoing recovery program to stay abstinent. They usually attend Alcoholics Anonymous (AA), Narcotics Anonymous (NA), or another 12-step program in addition to receiving ongoing professional treatment. They also make protracted efforts at psychological and physical rehabilitation and recommended lifestyle changes during abstinence. However, despite their efforts, these people develop symptoms of dysfunction that eventually lead them back to alcohol or drug use.

WHAT IS RELAPSE PREVENTION TREATMENT?

• Relapse prevention is a systematic method of teaching recovering patients to recognize and manage relapse warning signs.
  
• Relapse prevention becomes the primary focus for patients who are unable to maintain abstinence from alcohol or drugs despite primary treatment.
  
• Recovery is defined as abstinence plus a full return to bio/psycho/social functioning. As previously noted, relapse is defined as the process of becoming dysfunctional in recovery, which leads to a return to chemical use, physical or emotional collapse, or suicide.
  
• Relapse episodes are usually preceded by a series of observable warning signs.

PROGRESSION OF WARNING SIGNS:

• It is important to look at the dynamic interaction between the recovery and relapse processes. Recovery and relapse can be described as related processes that unfold in six stages:
  
• Abstaining from alcohol and other drugs,

• Separating from people, places, and things that promote the use of alcohol or drugs, and establishing a social network that supports recovery,

• Stopping self-defeating behaviors that prevent awareness of painful feelings and irrational thoughts,

• Learning how to manage feelings and emotions responsibly without resorting to compulsive behavior or the use of alcohol or drugs,

• Learning to change addictive thinking patterns that create painful feelings and self-defeating behaviors,

• Identifying and changing the mistaken core beliefs about oneself, others, and the world that promotes irrational thinking,

• When people who have had a stable recovery and have done well begin to relapse, they simply reverse this process. In other words, they:

• Have a mistaken belief that causes irrational thoughts,

• Begin to return to addictive thinking patterns that cause painful feelings,

• Engage in compulsive, self-defeating behaviors as a way to avoid the feelings,

• Seek out situations involving people who use alcohol and drugs,

• Find themselves in more pain, thinking less rationally, and behaving less responsibly,

• Find them in a situation in which drug or alcohol use seems like a logical escape from their pain, and they use alcohol or drugs.

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