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Relapse and Recovery: The Long and Winding Road

Skeptics point to the disturbing facts: more than half of Americans with addictions relapse within several months of treatment. But there’s another side to the story.

Chemical dependency is almost universally recognized today as a primary disease rather than a character weakness or a symptom of another psychiatric problem. It is, however, a complex disorder that affects not only physical health but mental functioning and social relationships.

Despite what critics may say, research supports the benefit of treatment––presumably the more thorough the regimen, the better the prospects for recovery. But there’s no guarantee, and patients most likely to avoid relapse are those who have the most going for them in terms of personal growth, family stability, social support and steady employment.

Addiction develops over a period of months or even years, resulting in the progressive deterioration of a personality and many of its healthy relationships. Most treatment professionals take the view that recovery is also a process, one that involves rebuilding that which has been destroyed. Although relapse is never welcomed, it may sometimes be a necessary way station in this process of personal growth and recovery.

The initial goal of most treatment plans is to “detoxify” the patient––to get the drug out of his or her system while monitoring adverse withdrawal reactions. But the abused drug retains at least some of its lure long after all vestiges are expelled from the body. For example, rats once addicted to a drug exhibit more signs of tolerance to that substance. A cocaine user is said to experience renewed craving for the drug at the sight of any white powder; an alcoholic knows he must avoid the bars he used to frequent and even some of his old friends. The environment apparently plays an important role.

A comprehensive treatment and aftercare program helps a patient learn to recognize the people, places and objects likely to trigger a relapse and anticipate a reaction early enough to head off serious problems. But social skills and self-knowledge are even more important. The recovering addict must learn to deal effectively with situations where the temptation is likely to be high.

And he or she must also recognize the biological signs of danger. Many persons in recovery say that stress, hunger, fatigue or anger––if allowed to build—can provoke a relapse. Learning to manage every day frustrations is an important part of the growth process.

Many addicts develop replacement dependencies during recovery. When an alcoholic turns to cocaine, the danger is apparent, but most new addictions are subtle. According to one counselor, the most common replacement addictions are workaholism, compulsive spending or eating and caffeine or nicotine abuse. In their search for security, some patients develop dependent relationships––seeking a person rather than a substance even if it is not in their best interest.

New patterns of behavior during recovery are generally healthy, but when work or exercise takes over too much of the patient’s life, the result can be a renewed cycle of guilt, shame and denial. At the very least, a substitute addiction is a sign that all is not well. The alcoholic who becomes stressed out in the workplace is at risk of reverting to alcoholic behavior.

Whether as a cause or a result of chemical dependency, many persons in recovery have personality traits that make them susceptible to relapse. Some are compulsively perfectionistic. For them, even a minor slip during recovery can trigger alarm and sometimes a rapid return to full-scale addiction.

Some individuals are unable to express their emotions directly, tending to retreat into their addictions when the going gets rough. Some are indecisive and unassertive, leaning on substances when friends or family are not available. Others are so narcissistic that they can’t accept constructive criticism and underestimate the severity of their problems. A few are rebellious, impulsive, thrill-seeking and antisocial; they are not good candidates even for Alcoholics Anonymous.

While some of these personality problems may have been addressed during treatment, they often require ongoing therapy. AA principles emphasize self-exploration and learning from others who are in recovery. The recovering person also needs to develop coping skills, a sense of purpose and tools for communicating emotions and forming meaningful relationships. For many patients, on-going individual or group psychotherapy may be required.

The Epidemiological Catchment Area survey conducted by the National Institute of Mental Health found that about half of Americans with a drug addiction also had another psychiatric disorder––most commonly depression, generalized anxiety and panic attacks. About seven percent had schizophrenia. For patients with a dual diagnosis, recovery is difficult. As one writer observed: “An alcoholic who is also schizophrenic should not be expected to recover as easily as a corporate executive without a psychiatric illness. . .”

A review of studies conducted over a 20-year period found that alcoholics from stable social backgrounds had success rates ranging from 32.4 to 68 percent following inpatient drug treatment compared to rates of 18 percent or lower for derelict addicts.

The distressing relapse statistics include skid row alcoholics as well as corporate executives, dedicated family members and others who have everything to gain from continued sobriety.

Behind the figures lies an important distinction. Relapse may seem like failure. However relapses can be learning tools to guide the individual on the road to recovery.

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Last modified: Tuesday, April 15, 2014

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