Treatment is Over. Now What if a Relapse Happens?
- Some of the most challenging aspects of recovery occur after treatment is over, because recovered people frequently suffer relapses.
- Family preparation for the post-treatment period can help minimize the damage and disappointment of a relapse.
Even effectively treated people with addictions will confront unexpected situations after they leave a treatment program and return to their home environment. These situations may produce intense periods of craving to re-use alcohol and other drugs. Lapse, defined as re-use of alcohol or drugs at least once following treatment, occurs in at least 50% of those who complete treatment. The most dangerous period for lapse is the first 3-6 months after completion of formal treatment. Relapse, defined as return to excessive or problematic use, is less common, occurring in approximately 20-30% of those who complete formal care in the prior year.
It is critical that patients, their families and friends prepare for the possibility of lapse and relapse. The preparation should include early detection of a lapse and establishment of steps to keep that problem from becoming a full-blown relapse. Two sets of activities can reduce the likelihood of relapse and reduce the severity if it does occur.
A good addiction treatment program prepares patients to:
- recognize they have a problem that will require continued management and monitoring
- learn and practice some of the fundamental skills needed to recognize and overcome the urge to use or drink when these situations emerge
- be engaged in a continuing care program such as AA and receive regular monitoring of substance use through urine screening or breathalyzer
- receive periodic phone calls or in-home visits following care to monitor their recovery
These generic elements of effective planning during treatment are among the best clinical practices available to forestall lapse. This planning should involve families so they can better understand the treatment issues, be prepared to support the recovery plan and be aware of signs of lapse.
To prevent and contain relapse the family should agree to fully participate in planned continuing care activities. Families and all concerned others can take five helpful steps:
- Have copies of the continuing care plan prominently displayed to reduce ambiguity and promote full communication and response.
- Early in formal treatment, ask the family member in treatment to describe in writing some of the very early signs and behaviors that may lead to his/her lapse and relapse. For example, he/she might write something like "I will begin hanging out with my friend Jimmy," "I will not do my homework" or "I will stop attending AA meetings." As the family member undergoes continuing care, regularly refer to these written descriptions to monitor the recovery process.
- During formal treatment, as the individual thinks about relapse scenarios, ask what s/he thinks should be done when early relapse signs emerge. Use these words to develop a contract that includes an action plan the family will follow when any of these signs surface. For example, s/he might write "take my cash and credit cards," or "increase the urine screens." Be prepared - before the relapse happens - to take the type of actions contracted.
- Receive and display the results of post-treatment urine screens. Discuss any positive results openly and honestly.
- Monitor and support changes that are consistent with a drug-free lifestyle. In other words "catch him doing something good" and then support it appropriately.