Vallarta Tribune, Mar 12-18, 2006, issue # 466, pg 20

 In addiction, we usually speak of those who are actively using and those who are sober and in recovery. There is another category that fits in between, those who often fall through the cracks and get lost or forgotten or who give up; the “chronic relapsers.” That’s right, the ones who never seem to acquire extended periods of sobriety (usually unable to make one year or to get past a few years at a time) Some can’t make it past 3-6 months and don’t know why, become extremely frustrated, and are accused of “not wanting it bad enough,” or of not “touching bottom.”Often, this is not true and should not be immediately assumed.

Relapse is a process

The phrase “recovery is a process” is commonly said and accepted, but not everyone realizes that “relapse” is also a process.  Relapse begins long before the actual return to drug/alcohol use. There are many ways of thinking and behaving that occur beforehand, influencing the person who is struggling to be abstinent or sober, which must be recognized in order to prevent relapse.

To many addicts it may seem that their relapse comes out of nowhere. From their perspective,  they have worked hard to become sober and makelifestyle changes, including giving up certain friends or drug using acquaintances, or not returning to places and things that were part of their addiction or that would put them at risk. They have fought to tolerate many situations such as an unhealthy relationship held together by only a thread, an unsatisfying job or being unemployed, or being in debt. Suddenly one day, WHAM!! before they know what hit them, there they are face to face with their addiction, with their drug staring them in the face. Now what?!

Relapse Prevention Planning

Create a relapse prevention plan! Terence Gorski is a renowned relapse prevention expert in the addiction field who determined that a much more realistic goal for chronic relapsers is to have a shorter, less intenseless destructive relapse instead of relapsing and getting stuck in their addiction not knowing a way out. It is important not to equate relapse with failure, to never give up, and always ask for help. Gorski said, “If you relapse, it’s best to get help while you still have hope, dignity, and friends you haven’t pushed away.” Fortunately, we have Gorski’s model to guide us in helping create a relapse prevention plan based on experiences of thousands of addicts whom he interviewed. He identified 48 warning signs and chronologically placed them into 10 categories according to the relapse process progression. He also divided the recovery process into 6 stages and his model relies heavily on participation in 12-step programs (Alcoholics Anonymous (AA) and/or (NA) Narcotics Anonymous).

Addiction is a disease

In attempting to understand causes and factors of chronic relapse, it is especially important to consider the physiological addiction or dependency to drugs and alcohol.

“Chemical dependency” (including alcohol) is a primary disease which damages the nervous system impairing thinking and emotions. Mind-altering chemicals change brain chemistry and brain function which cause physiological, psychological, and behavioral changes.  (Gorski, “Learning to Live Again: A Guide for Recovery From Chemical Dependency,” 1992, pp: 11, 17, 22)

Tolerance, dependency, and cravings

Specifically the brain chemistry and balance becomes affected. Brain cells (neurons) send messages to neuron receptors. Chemicals (neurotransmitters) are the vehicles that transport these messages over the neurons and from one receptor to another. Some people are born with brain chemistry imbalances already and may unknowingly seek certain drugs (alcohol or cocaine for example) to correct the imbalance, while others develop an imbalance caused by other factors including “foreign” chemicals such as alcohol, nicotine, caffeine, cocaine, heroin, etc. This causes the brain cells to release less of the natural brain chemicals, the receptors become less sensitive, and so more receptors are created.Therefore, more of the mind-altering substance is needed for the same effect, otherwise known as “increased tolerance”. Over time, more and more brain cells adapt and new balance is achieved, which feels normal. (Gorski, “Learning to Live Again: A Guide for Recovery From Chemical Dependency,” 1992, pp: 22-23)

No wonder they relapse

Since the cells have adapted, when an addict decides to cut back on their use or quit using completely, it causes a painful reaction because the brain chemistry is thrown out of balance once again. Not using creates pain and the need for pain relief leads to continued use and so the cycle of addiction continues. It’s no wonder so many addicts have such a difficult time maintaining abstinence and chronically relapse, eventually give up and chose to relieve the pain, knowing that it could be fatal!

Oh my aching brain

 In addition to 12-step work and relapse prevention counseling/therapy, treating the brain chemical imbalances can be very effective. Over time, the brain can become irritated and eventually permanently damaged. An EEG (electroencephalogram) is needed to identify what if any irritation or damage has occurred and in which lobes of the brain. Depending on which lobes are involved and the extent and severity of the irritation or damage, a variety of things could be impacted such as: behavior, memory, judgment, ability to control impulses, tolerate emotions, learn from experiences, problem-solving skills, ability to pay attention and concentrate. There are some psychiatric medications available that can either help correct or counterbalance the effects of the irritation or damage. It is amazing how much difference these medications can make and how much more attainable sobriety and recovery is once the person is being treated.

No addict is hopeless!

Written by: Giselle Belanger, RN, LCSW, CADC