What is Relapse?
Relapse is more than a return to drug use after a period of abstinence. It is a progression of feelings and events that leads to substance use after a period of abstinence. It is a failure to use new coping strategies and avoidance skills, and a return to old ways of thinking and behaving. Relpase is a process that begins long before someone picks up again.
Terrence Gorski, an expert in relapse, says that the relapse chain often begins with something the user believes is insignificant, an “apparently irrelevant decision.”
Relapse is common. On average, people experience 2.3 treatment episodes on their way to prolonged abstinence (6+ months). Up to 90% of alcoholics are likely to experience at least one relapse over the four year period following treatment (relapse defined as re-use).
Types of Relapse
There are slips and there are falls: relapses are not all the same. They vary by:
- Duration
- Extent of use
- Context/situation
- How discovered
- How handled after
An isolated incident of drug or alcohol use that does not result in a return to previous patterns of behavior can be considered a lapse. In this case, the person immediately lets others know what has happened, and takes steps to prevent future slips by examining the episode in detail and revising the relapse prevention plan. This should not be treated the same as a more intense relapse.
Signs of Relapse
Just like signs of developing addiction, one of the cardinal signs of relapse is change following improvement. This might mean not following rules, impulsivity, or reduced attention to appearance and hygiene. It might be seen as poor grades or work performance, or decreased attention to job or housing search, or less focus during parent/child visits. These are all symptoms that can be noticed by court and child welfare professionals.
Some people who are in the relapse process put themselves in drug situations as a test – maybe going to a party where there will be drugs, or walking by their favorite bar. Some even try to have a few drinks or drug doses to see if they can maintain control.
Responding to Relapse
When a person relapses, the first step is to suspend the current treatment plan, help the client stop using.
Once the client has been re-stabilized, there should be a formal assessment and deeper inquiry into the relapse. When did the process begin? What happened specifically? What came next? What were you feeling? What are all the holes in the current treatment plan, and what can be shored up?
With these questions answered, the treatment plan should be adjusted in response, and the level of care re-assessed to ensure that there is no need to step to more intensive services.
How People Feel When They Relapse
People who relapse rarely feel proud of their behavior. On the contrary. They feel guilty and angry, frustrated and ashamed. They also feel depressed and anxious.
Relapse Rriggers
There are as many relapse triggers as there are individuals. But there are some situations that are more frequently linked to a return to substance use. Certainly feelings of inadequacy, stress, unresolved trauma, anxiety, and depression are all factors that contribute to relapse.
Consider some common situations faced by parents involved in the child welfare and family court systems:
- Challenging child behaviors
- Feeling judged by others
- Unresolved grief and loss
- Ambivalence about parenting and reunification
- Intimate relationships with active drug and alcohol users
- The difficulties of complying with service mandates
- Trauma of separation from family
For some people, particularly men, relapse triggers come in unexpected packages:
- Achieving success
- Free time
- Celebrations
Questions to ask about a Relapse
While drug treatment professionals need to explore lapses and relapses in depth, child welfare and family court professionals can also help parents think through the situation by asking any of the questions below:
- Have you talked with your child about your slip?
- Have you talked with a counselor about your slip?
- What did you learn from this episode?
- What do you think you’ll do differently next time?
- How are you adjusting your treatment plan?
- How do you think your relapse/slip has affected your child? Your family?
