When someone has a Substance Use Disorder with alcohol or drugs, and relapses, it means a return to sustained and frequent substance use after a period of no use. But it can be an important teachable moment. In this article I describe what relapse is, what to say and not say to someone who is relapsing, and how to help.
What Does “Relapse” imply?
According to the National Institute on Drug Abuse between 40 and 60 percent of people relapse within one year of treatment. So relapse is part of the normal cycle of addiction. But there is a significant risk of overdose if, during relapse, someone uses as much of the substance as they did before stopping, since the brain has adapted to not having substances in its reward system..
Relapse has multiple forms and stages from emotional relapse, to mental relapse to physical relapse. The first two may begin some time before the actual physical stage of resuming to abuse alcohol or drugs. Emotional relapse is largely about denial. In mental relapse it looks like the person doesn’t want to physically use, but they are constantly thinking about how using may decrease their emotional distress.
Signs of relapse include:
- Cravings
- Bargaining
- Lying
- Isolating oneself
- Changes in eating and sleeping habits
- Avoiding friends and family
- Minimizing consequences of past use
Recovery is a learning process. Relapse is a risk before the brain has rewired itself toward non-drug related rewards and before a person has acquired a new set of strategies for managing not only cravings, but life stressors. The risk of relapse is highest in the first 90 days following treatment, while the person adjusts to their new life and establishes rewarding substance-free daily routines.
It’s important to distinguish between relapse and a lapse. Most often people relapse because they are triggered by cues of their past drug-using life, such as seeing a familiar place of drug use or connecting with past drug-related friends. A lapse, or slip-up, is a short-lived, often accidental return to substance use, usually due to an inability to cope in a high-risk situation.
Viewing lapses as slip-ups help minimize guilt and shame that the person may feel due to an inability to sustain their abstinence. Relapse is a learning opportunity as a sign that more intensive support may be needed. It’s especially critical in the first ninety days of recovery.
What to Say to Someone Who Has Relapsed?
Listen
Paradoxically the most important thing to say is to say little and listen intently without judgment. Be aware of your posture and body language. No one likes to be lectured. Create a safe space to talk while they share their feelings and explain what happened. The person will usually not ask for advice at this point. Allow them to just unload their feelings. It’s key to be empathetic so they don’t withdraw. Be supportive and positive that this is something they can get through, with help.
Be Encouraging
The biggest fear of someone who has relapsed is that they won’t be able to achieve their goal of long-term sobriety. With encouragement you can help them resume their progress. Words such as “I know you can do this” or “I believe in you” can be powerful affirmations for the person’s confidence that they can reach their goal.
Be Empathetic, with Understanding
When someone relapses they are often overwhelmed with shame, guilt and embarrassment. This may be especially so if they have made a commitment to you. Reinforce that you understand this was not their wish and that your care for them has not diminished.
Set Limits
As a family member or a friend and not an addictions professional, you are not responsible for the person’s actions. Nor should you feel they are taking advantage of your kindness. If the person is motivated to restart their journey to sobriety, establish some ground rules with consequences and follow through as needed.
You Haven’t Failed
Share the fact that many others also relapse before reaching long term sobriety. Reassure them that relapse and setback are part of the journey to long-term sobriety.
I Know Your Goal is to Remain Sober
Congratulate the person for deciding to seek treatment. Reinforce their decision to continue.
You Have My Support
You’re not alone. Allay this fear. I’m available.
What Have You Learned From This?
The ability to reflect is an important part of the learning process. Ask the person questions to help turn a challenge into a learning experience.
How Can I Help?
Help the person stay in the present, referencing the mantra “One day at a time”. Sh,are simple things with them such as a walk or cooking a meal.
Phrases to Say
- How do you feel?
- Can I help in any way?
- How are things going?
- This is a bump in the road.I know you can stay sober again. You did it pretty well before.
- You’re stronger than you think
- I’ve seen your courage. I’m confident you can find that again.
- With this relapse you’ve learned more about your triggers. Use that learning.
What Not to Say to Someone Who Has Relapsed?
What Happened?
Don’t probe about the causes of the relapse. Focus on the person’s warning signs and ways you can support them,
I’m Disappointed
Projecting your desire for the person to have it all together and not relapse does not help, even though you may feel disappointed, frustrated or angry with them. It’s best to focus on the relapse or lapse as a small setback and discuss the person’s relapse prevention plan.k
Don’t Review Their Progress
It’s none of your business to review the therapy even though you may have been deeply involved in the past trying to control their substance use.
The Treatment Approach You’re Getting Isn’t Good
Presumably the person had a say in which treatment approach they were participating in. Check your feelings casting doubt on that treatment, just because the person relapsed. What works best is treatment that aligns with the person’s own goals.
How to Help Someone Who Has Relapsed?
Recovery is a lifetime process. Share with them that you understand this and appreciate their struggle and how difficult it can be. Show your pride in their achievements to dat. Show confidence in their ability to follow their relapse plan and recovery goals. With help and non-judgmental support they can maintain their sobriety.
The Importance of Professional Help
Recovery from addiction is hard and involves a journey of many steps, relapse among them. It can also be very emotionally intense for family and friends. In addition, there are risks along the way, particularly if someone resumes substance use after a period of sobriety. If you see the earlier emotional and then mental signs of relapse, seek professional help. The psychological and medical elements of recovery require trained counselors, therapists and medical professionals to counsel and guide the person to sobriety.
Help Is Available
If you or someone you know is showing signs of addiction or mental health issues, reach out for help. Compassionate licensed addiction specialists are available at The Encino Recovery & Detox Center. Remember, taking the first step towards recovery is a sign of strength. With the right support and treatment, overcoming addiction is possible, paving the way to a healthier, more fulfilling life.
