Relapse is not an event; it is a process, and it happens in stages. A relapse doesn’t always mean that the person has started to use drugs or alcohol again. Relapse can mean that the person is slowly losing stability and setting themselves up for relapse. A common question that we get is simply – how do I help someone who is relapsing? It can be difficult to know what to say to someone who relapsed, or how to deal with their relapse when you and they have already been through this many times.
The key thing is to remember that relapse does not mean failure. In fact, it is quite common. With both drug addiction and alcohol addiction, the chances of relapse are 40-60%. It is part of the recovery process, and an opportunity to learn from mistakes and strengthen one’s recovery.
Like addiction, relapse is best addressed as early as possible, before the person falls off the wagon. For this, it is important to notice the main signs of relapse.
- Signs of Alcohol and Drug Addiction Relapse
- What to do When Someone Relapses
- What to Say to Someone Who Has Relapsed
- How to Deal with Relapse
- Get Help for Someone Who Is Relapsing
- Relapse and Risk of Overdose
- How Castle Craig Can Help
As part of the Castle Craig Hospital relapse prevention programme, participants are given a checklist of relapse warning signs which they are encouraged to use every day to monitor their own wellbeing. This can be a valuable tool in taking preventative measures at an early stage, should they be needed.
Signs of Alcohol and Drug Addiction Relapse
The signs to look out for when one suspects a drug or alcohol relapse will depend on the stage of relapse. In the first stage, also known as emotional relapse, a person doesn’t think about using again, but they are setting themselves up for physical relapse. In the second stage, mental relapse, a person will start to negotiate with themselves about potentially going back to alcohol or drugs. The third and final stage, physical relapse, is when the relapsing alcoholic or drug user goes back to their old habits.
During any stage of relapse, the signs of relapse are similar to signs of addiction. Of course, with physical relapse, one has to look for signs of alcohol or drug use, just like in the beginning of actual addictive behaviour. However, the signs of relapse come far earlier, before the first slip.
Emotional relapse can happen months before physical relapse. Hence, if it is not addressed, it can quickly grow into a serious problem. However, since it is the earliest stage, it is also the easiest to pull back from. And if you have been through this before with your loved ones, you may start to recognise the signs. Remember – this is the easiest time to help someone who is relapsing, so be sure to look out for any issues that arise.
When entering emotional relapse, a person may show signs of:
- Behavioural or emotional changes
- Mood swings
- Problems with work/school/family
- Neglecting self-care
- Refusing to ask for help
- Neglecting continuing care plans
- Not attending support group meetings
If not addressed these signs will be followed by mental relapse and eventually become triggers for physical relapse.
Mental relapse is tougher to return from, especially if allowed to progress. Signs of mental relapse include:
- Nostalgia about using alcohol or drugs
- Glamourising past use
- Denial about the past or current problem
- Hanging out with old friends who drink or use drugs
- Fantasising about relapse
- Negotiating that “just once” won’t be a problem
What to do when someone relapses?
Whatever the stage of relapse, it is important to stay supportive. They need you now more than ever. Both the person and their loved ones need to remember that addiction is a disease and not anybody’s fault. Everyone can make mistakes. However, it is also important to balance this with the fact that just because they are sick, their addiction is not an excuse for bad behaviour. Here are some suggestions for what to do after a relapse:
Identify the Triggers:
To prevent relapse from happening again, it is important to identify what caused the problem in the first place. This might be as simple as avoiding a certain person or place. For example, if Kate, a recovering alcoholic, knows her book club friends always drink a lot, she might want to decline future invitations to hang out with them. If you are aware of the problem, you have the power to fix it.
Stay supportive, just like you have been during their addiction treatment. Don’t show hate or anger, even if you are emotionally overwhelmed. The person relapsing needs you now more than ever. They probably already feel like a failure, so they need to know there is someone they can rely on.
Don’t Enable Them:
While being supportive is important, in order to really help the person relapsing, you need to stay somewhat emotionally detached from the situation. You should keep a clear head when you confront the issue. Be firm when you address the person and do not minimise the problem. Make sure they know that, ultimately, they are responsible for their own well-being and recovery. You can help them along the journey, but it is their journey to take. Avoiding falling into the trap of co-dependency is crucial for both you, and your loved one.
No one likes to be told off, especially someone who is already dealing with the stress of addiction and relapse. Don’t take away their guilt, but don’t make them feel worse. Try not to make invalidating statements. Don’t remind them of their past mistakes. They’ve worked hard to change, and they should feel like they’ve made progress. If you make the person feel more like a burden than they already feel, they will be less likely to listen to your advice or ask for help in the future.
Encourage and Motivate:
Remind the person about how far they’ve come already. They’re made it through treatment, have been abstinent for X days, and they can do it again. Take a look at their aftercare plan again, and encourage them to take it step-by-step. Perhaps, offer to drive them to their fellowship meeting, or go with them.
Discourage Bad Behaviour:
Likewise, discourage bad habits. If they are hanging out in a risky environment, or with old friends they used with, explain that this is not a good idea, and suggest alternative activities.
Take Care of Yourself:
A core part of how to deal with a relapse is self-care. Relapse is just as tough on you as it is on the relapsing alcoholic or drug user. To help someone who is relapsing, you need to make sure you help yourself first. And during this time, you should be careful not to become co-dependent, as it enables addictive behaviour. Make sure to get counselling or attend peer-support groups as a way of keeping your mental health in good shape.
Be the Change You Wish to See:
By taking care of yourself, you are also setting an example for the person in relapse. If they see you maintaining a stable life, eating well, exercising, keeping up with your day-to-day duties, they will be more motivated to follow in your footsteps and get better.
What To Say To Someone Who Has Relapsed
Tackling the problem of a relapse isn’t just about what you do for your loved one – what to say to someone who has relapsed, and making sure you don’t push them away with the wrong words, is just as important. Here are some suggestions to approach the issue:
“I’ve noticed [signs of relapse], is everything okay?”
This statement expresses concern without being nosy. If a person is stressed out, they will appreciate your caring approach. It can also be helpful for them, if they don’t realise they are experiencing emotional relapse.
“Do you know what happened?”
Helping identify triggers can be a major asset not only in helping the current situation, but also in preventing relapse in the future. In addition, the person may not realise why they relapsed. It can be helpful to walk through what triggered the relapse in the first place.
”I’m proud of how far you’ve come. We can get through this again!”
This shows not only your support, but reminds them about their achievements and encourages them to keep going on their journey to recovery.
“Is there anything I can do to help?”
This goes back to identifying what triggered the relapse. Perhaps the person has become overwhelmed from work or school. Maybe they need a babysitter and to have a night off now and then. Or maybe they feel isolated, and would appreciate more social interaction. And if you help out someone who is relapsing in this way, they will not only be less stressed about their trigger, they will know how much you care for them. But again, be careful not to enable them.
“Relapse can be a helpful experience if you learn from it.”
If they are prepared to look at their behaviour and attitudes through the developing stages of relapse, they will have a clear picture of where, when, and how things went wrong, which will be of great help for them in the future. Learning what to do after a relapse is an important part of recovery.
When a person returns to Castle Craig for further treatment following a relapse, one of the first things they are asked to do will be to write an account of their relapse in detail. They will use this to identify the way the relapse process developed including mistakes they may have made and the points where they deviated from their continuing care plan. This can becoming a unique and powerful tool in helping changes to attitudes and behaviours so as to ensure the scenario is never repeated.
How to Deal with Relapse
If you are dealing with relapse yourself, make sure to ask for help as soon as possible. Remember, it is okay to make a mistake, as long as you take the steps to correct it. Keep a positive outlook. Don’t neglect self-care. Refer back to your continuing care plan, if you have one, and start attending counselling or peer support groups again if you’ve stopped.
Dealing with both addiction and relapse are tough not only on the addict, but on their loved ones as well. Family and friends should be reminded that while it is important to help the person who is relapsing, it is also important to take care of yourself.
Family and friends should not hesitate to attend peer-support groups for loved ones, such as Al-Anon or Nar-Anon. Relapse can feel extra stressful, because you may have thought that the problems have been left behind after your loved one completed treatment. Now, more than ever, is it important to stay strong.
Get Help for Someone Who is Relapsing
If this is your loved one’s first relapse, or even if it isn’t, it can be difficult to know when to step in, or what to do when someone relapses. Referring back to their aftercare plan is a good start for addressing relapse. After all, aftercare is provided as a means of relapse prevention.
If they do not have one, attending a fellowship meeting, either for people with an addiction, or for families and friends of addicts, can be a great resource as well. Likewise, local addiction clinics often offer help to family and friends.
If environment is a problem, such as they live with people who drink or use drugs, suggest sober housing. Living with people with similar problems can be helpful. In addition, sober homes tend to offer the discipline and structure of a residential rehab, which can be helpful in maintaining recovery.
If they have been through outpatient treatment programmes, and have relapsed more than once, you may want to consider a residential rehabilitation programme. Take some time to research rehab options and offer suggestions for treatment. They may be too overwhelmed themselves at first, but with your encouragement, they will be more likely to accept help.
Relapse and Risk of Overdose
Some people may not know that the risk of overdose is higher among people during a period of relapse. This is explained by a number of factors.
If a person has a physical relapse, the overdose is likely to be accidental. This is because even after a brief period of abstinence, one’s tolerance levels will decrease or reset. So the amount they were previously using will now be too much.
Even if the person is aware of this fact, a physical relapse can feel like such a release that the situation becomes overwhelming and exciting. Hence, they may not have the same control because they are finally getting their first drink or dose of drugs.
Another factor that adds to the risk of overdose is using alone or in secret. A person who relapses will likely feel guilt and shame, and may not want others to know about their slip. Perhaps before they used to use or drink with friends, but this time they may do so in secret. This can lead them to make poor decisions, while not having anyone to look out for them.
These risk factors show how important it is to prevent physical relapse, by addressing it in the very beginning. It also shows the importance of staying supportive, because if the person does slip, at least they have someone to ask for help when they are relapsing.
How Castle Craig Can Help
One exercise that is often used in the Castle Craig relapse prevention course is having participants write a short piece entitled “My Relapse Will Happen As Follows”, which involves them imagining the events that would lead them into relapse. If honestly done, it can help people focus on the reality of the particular dangers they will face and to plan accordingly. Here is an example:
“As I say goodbye to my therapist I say “I honestly don’t want to use drugs any more, I’ll be ok”. I really believe this. When I get home, my girlfriend is all over me and I get the feeling she’s watching me all the time and doesn’t trust me. I tell her to leave me alone and she gets upset. It’s a tense atmosphere that goes on for days and eventually I suggest she stay with her mother for a couple of days to “give us both a break”.
My girlfriend goes reluctantly and I tell myself at last I can concentrate on me and my recovery but instead I don’t bother going to a NA meeting and watch tv. The idea comes into my head that I could smoke a joint and no one would ever know. I put the idea away but it keeps returning and late that night I phone a pal and pick up some weed. It’s downhill after that”.
Writing this enabled the patient to see the stages of relapse – emotional (the girlfriend situation), mental (subconsciously arranging time alone and failing to recognise the need to give absolute priority to recovery) and physical (phoning a pal). He worked on techniques to deal with cravings and arranged an NA contact whom he could talk to at any time.
Castle Craig has developed these, and other methods, to prepare people for life after treatment. Using our unique treatment model, which is a 12-step based, fully medically managed rehab, we have spent 30 years treating people with addiction. We try to give people the best chance of recovery after they leave, and focus on giving them the tools to help themselves from relapsing. But we understand that addiction is a chronic, recurring disease, and relapse is normal. That’s why we offer continuing care to everyone after they leave, and foster a strong community of previous patients and their families. And for anyone who finds that they need to come back, we are always here to help.