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Top 5 reasons addicts relapse
Insanity: Repeating the same behavior over and over and EXPECTING a different result” (C’mon, you know what the results will be). Back in 1999, I found myself in one of my first psychotherapy groups and the group facilitator said, “Look to the left, then to the right, as only one of you will stay sober!” Over the last 30-40 years countless addiction professionals have attempted to predict treatment outcomes. The reality is, due to the nature of the disease and instability of the addict, outcome studies are rarely accurate and difficult to conduct. Having spent the last quarter century studying the disease of addiction and the maladaptive behaviors addicts engage in to maintain their addiction (the first 12 years in research and development; the past 13 treating addicts including myself), I think I’m qualified to answer one of the most common questions that EVERYONE asks; what the prognosis is? What are the percentages? You know what I tell them, “if you do everything I tell you to do and everything the thousands of addicts who have arrested their own demons do, it’s 100%”. Below are my top five reasons addicts relapse.
- The addiction landscape has changed – In my opinion one of the most important super bowl commercials in recent history aired during the 2008 SB, and it portrayed a down and out drug dealer struggling for business. He’s sitting next to pay phone that is not ringing and he’s complaining that kids nowadays are getting their supply from relative’s medicine cabinets. This is a problem when OxyContin or Xanax has superseded nicotine, marijuana or alcohol as the “gateway” drug. These synthetic pills produce intensified, protracted withdrawal. Additionally, most addicts seeking treatment are dependent on a multitude of substances causing cross-addiction and significant chemical imbalance in the brain.
- Average age of onset – Never before have we seen so many addicts under the age of 25 enter rehab. Adolescents are abusing substances at an alarming rate. Unfortunately, it is between the ages of 13-22 that the prefrontal cortex of the brain, the part of the brain responsible for decision-making and impulse control is developing. Alcohol and other drugs stunt the development of the prefrontal cortex leading to impulsivity and poor decision-making. The transition from adolescent to adulthood is a scary proposition for well-adjusted individuals. Add these dangerous mood/mind-altering chemicals into the mix and you have a recipe for disaster.
3.Managed care – Insurance carriers “graciously” authorize three days of detox and seven days of residential treatment before politely saying, “we think he can be treated in an outpatient setting”. Really, I mean for God’s sake, after 10 days the person still has traces of the benzodiazepines from detox, they’re not sleeping and their cravings are through the roof!
- Insufficient aftercare plan – The treatment model is incomplete and as a result of inadequate follow up immediately following residential, partial and intensive outpatient treatment, addicts return to their old coping mechanisms. The gap between intensive outpatient treatment and sustained sobriety is a critical factor in the relapse process and it needs to be closed. There is no continuity of care; a case manager hands the client a list of health care providers in their home area, and we expect the 18-year-old to call and schedule an appointment, to join a 12-step self-help support group, to return to school where all the other 18-year-olds are drinking there way through college and to join the work force. Insufficient aftercare planning falls on the shoulders of all parties involved, whereas the next item falls squarely on the shoulders of the addict.
- Not applying roadmap of treatment suggestions – Go to any 12-step meeting and you’re likely to hear, “you’ve got to change old people, places and things”. The fact that the majority of the addicts I treat are from another state is indicative of the need to get away from their triggers. So when I ask them, “What happened”, the majority of the time it’s, “I went home”. I refer to this as “returning to the scene of the crime”. Another warning sign that relapse might be looming is when the addict decides to discontinue anti-craving or psychotropic medications without consulting a physician. It always befuddles me when I hear an addict say, “I don’t want to depend on any medication”. So you have no problem sticking a needle in your arm or smoking crack-cocaine, but you’re unwilling to take an FDA approved medication that will help you cope with cravings or a mood disorder that either exacerbates your addiction, or is exacerbated by your addiction.
DENIAL (don’t even know I am lying). I always say that the disease of addiction is the only primary medical disease where the patient denies having or disease or minimizes the severity of it.
CHIEF ENABLER (you know who you are). Usually a family member, friend or colleague, someone who will co-sign their addiction by funding it, cleaning up the negative consequences caused by the addiction, and/or taking care of the addict’s responsibilities. A chief enabler can undo 30 days of therapy in 5 minutes by contradicting the aftercare plan.
BALANCE (that thing normal folks do). For many addicts early recovery is all about that, RECOVERY. The most difficult decision of the day is what meeting to attend. Add family, career, and leisure activities and you have a loaded plate!
Identifying warning signs, triggers, feelings and high-risk situations leading to relapse, as well as, escape plans for each one should be a treatment plan objective for each and every addict who enters substance abuse treatment, and remember if you do everything we tell you to do the prognosis is good!
David Levin is the Clinical Program Director at Our Place Recovery.