Thoughts On Relapse
by Nancy Smith Beste
We expect relapse during recovery from substance abuse for the same reason we expect relapse when a patient is learning to deal with diabetes, hypertension, obesity, or any other chronic disease. Substance abuse is a disease that some people are predisposed to genetically. Whether it develops or progresses depends on our life experiences. By the time substance abuse is diagnosed it is ingrained as a part of our person with habits that reinforce it. The factors that brought on the disease are complex and the recovery is just as complex. Recovery requires ongoing treatment and relearning of behaviors. Change is always difficult but when it involves giving up behaviors that have helped us cope with obstacles we perceive it is a rigorous process fraught with relapses. Relapse seems easier. Relapse is a part of the process of recovery.
The development of a chronic disease, including addiction, is often rooted in genetic predisposition. What happens to a person from birth forward determines if and when we develop the disease. This includes environment, socialization, culture, addiction, interpersonal relationship, successes and failures, and often trauma (physical, emotional, financial, sexual, any kind) . Substance abuse sometimes begins as a coping mechanism for dealing with painful physical or emotional challenges. Removing the substance leads to the need to deal with problems one has suffered. Sometimes examining problems seems more painful than the consequences of substance abuse.
A person struggling with addiction rarely is facing only addiction. Often substances became a rewarding pathway to the person because other issues made life complicated. People with addiction, like all people, are faced with many life challenges. These include other medical issues like pain, psychiatric disorders, or other diseases or injuries. Some people choose substances to cope with medical issues. Substances block pain.
Sometimes the environment we live in and the social structure we are a part of can create obstacles that make thriving difficult. Some patients chose substances to provide relief from trying circumstance like poverty, lack of opportunity overwhelming responsibilities for family or job, or hopelessness about finding life happiness. Life stresses are increased when loved ones die or become ill, a job is lost, pregnancy happens, a physical accident occurs, property is destroyed by catastrophe. The obstacles in life are unending. Substances divert attention from problems.
When circumstances appear bleak or life looks monotonous, some people turn to substance use. This is most likely to occur when substances are available. The behaviors which predispose and worsen addiction or other disease states are sometimes behaviors chosen by an individual to somehow fulfill needs for stress reduction, increased happiness, relaxation, avoidance, defiance, belonging….. These behaviors have been honed and nurtured for a long enough period of time to allow addiction to take over. By the time addition takes over the substance is the “go to” means of coping.
By the time addiction is diagnosed the user has developed many behaviors that support it and lead to disease progression Disease progression, as with any disease addiction causes physical changes. With substance use the brain and body adapt. The body reaches homeostasis with the substance as part of the balance. Removing the substance causes physical discomfort and mental discomfort. The human response is to prevent the body from going without the substance in order to avoid withdrawal. A substance dependent person begins to feel normal only when using the substance. The substance and how it makes him or her feel becomes a part of who that person is. Not only does the addicted person experience withdrawal when stopping use of the substance, but the substance abuser must also learn who he or she is and learn how to live, cope and find joy without the substance.
It seems easier to relapse than it is to recover. Substance use is familiar. It is a habit. Association with perceived relief from the substance is remembered through subliminal and blatant triggers. Even if the use of the substance no longer brings relief the memory of substance use makes relapse attractive. Easy availability of the substance makes relapse more likely. Associations with friends or family who also use re-enforces usage and make relapse even more likely. Having friends or family members who use makes relapse more acceptable and easier and the substance more available. Watching family members or community members use, models the behavior and makes substance use a viable alternative.
Most substance users despite multiple failures to quit and terrible consequences from substance use, believe they are able to control their use of the substance. They don’t believe they need treatment to overcome the issues associated with usage.
Detoxification causes withdrawal symptoms and even with medical assistance physical and mental discomfort is usually present for sometime after quitting usage of the favored substance. The substance changes the function of the brain and body and it takes time for neurotransmitters and chemicals in the brain and body to rebalance so the newly sober individual can deal with stress, sleep normally, think clearly, and begin to find joy in life without the substance. This process characteristically takes three months, a year, or more. It is far easier to revert to using.
Recovery is a process rather than an end point. Relapse is often part of the process Recovery from substance abuse is usually a tangled web of periods of abstinence from the substance intertwined with relapses. Successful recovery is rewarding life experiences during the periods of time without substance use and fewer and less destructive relapses.