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Dr. Steve Frisch, Psy.D. is a clinical psychologist in private practice in
Chicago, Illinois and Northfield, Illinois.

You can contact Dr. Frisch, Psy.D. at
(847) 498-5611.

Learn how to prevent and recover from chemical dependency as well as the aftereffects of chemical dependency on you and your family. Read Dr. Frisch’s, Psy.D. series of Recovery books.


What is Relapse?


D
ear Dr. Steve:

I am so angry with my son I can hardly see straight. Three inpatient treatment programs and $45,000.00 later, he is still drinking and drugging. I’ve been to all of the lectures. I’ve sat in on more family sessions than I care to remember. I’ve been told countless times by very nice people that my son has a disease, that he’s not to be blamed, and that there are no guarantees. Anytime I press for hard answers as to why my son walks out of a treatment program and goes straight to his dealer they just tell me that I have to let go and let God. That’s all fine and well. But five years after the fact, my son can’t stay straight for more than six weeks at a time. And then it’s back to the same old thing—lots of good intentions, followed by lots of empty words, followed by lots of broken promises, followed by lots of unpaid bills, followed by lots of eviction notices, followed by some emergency room crisis, followed by my wife and I putting my son back in rehab, followed by short periods of abstinence, followed by lots of good intentions … Why can’t my son just quit?

You deserve an answer to your question. However, I’m afraid that the complexities of the answer still won’t be enough to lessen the hurt and fear that is overwhelming you but I’ll try. The factors that contribute to relapse are as many and varied and interrelated as the strands of metal that are woven together to make a cable wire. In this column, I’ll address only one aspect of what contributes to relapse. The aspect that I’m going to address is the unique stressors that confront somebody in their first year of attempted abstinence. Those stressors are: 1.) protracted withdrawal, 2.) safely facing the emerging facts and awakening feelings about one’s life, 3.) internalizing an identity that acknowledges one’s inability to control their drug and alcohol intake, 4.) mastering a series of life skills that support the newly abstinent individual’s choice of sobriety.

As you already know, chemical dependency, whether it is alcoholism or drug addiction is a primary, chronic, progressive disease that is prone to relapse. Although a recovering alcoholic and drug addict will always be vulnerable to relapse, people who are in their first year of abstinence are particularly vulnerable to relapse. There are physical and psychological reasons that people are especially vulnerable to relapse in their first year of abstinence. One reason has to do with the phenomena of withdrawal. Although symptoms from the acute withdrawal from alcohol and drugs manifests themselves for a relatively short period once an individual has become abstinent, there is another phenomena that an abstinent individual must contend with. That phenomena is called protracted withdrawal. The period of time that protracted withdrawal affects an abstinent individual varies from individual to individual. Some of the variables that affect how long someone is vulnerable to symptoms of protracted withdrawal are frequency, duration, and types of drugs an individual used. The reason that protracted withdrawal makes an individual vulnerable to relapse is because of the physical and emotional effect it has on that individual.

You can see how protracted withdrawal may make someone vulnerable to relapse. Most people, once they go through the initial pain of withdrawal believe that they should feel as good as new. However, if an individual doesn’t feel as good as new, they are vulnerable to feel disappointed, resentful, and disillusioned. If they don’t take the time to factor in the phenomena of protracted withdrawal and if they haven’t developed the necessary skills of abstinence, then they are prone to medicate their discouragement with drugs and alcohol. Their old way of thinking may kick in and they’ll justify taking a pill that will finally allow them to sleep or they’ll take a pill to help them feel re-energized. Or their discouragement will just get the best of them, so they give up altogether and go back to drinking and drugging.

Besides protracted withdrawal, there are other stressors that people who are new to abstinence are particularly vulnerable to. Awakening feelings that were previously medicated can be very disturbing to the newly abstinent individual. An expanded awareness of what their lives had become is another stressor that the newly abstinent individual must learn how to deal with besides drinking and drugging. Until the newly abstinent individual develops fundamental coping skills to deal with the stressors of their life without the use of drugs and alcohol, their raw emotions, their fragile psyches, and their reliance on new untested behaviors as coping mechanisms makes the newly abstinent individual vulnerable to relapse. These vulnerabilities can be successfully overcome in time through 1.) education about global relapse risk factors,
2.) identification of personal set-ups for relapse, and 3.) the mastery of alternative behavioral strategies.

A third reason people in early abstinence are vulnerable to relapse is because not all people who attempt to become abstinent intend to remain abstinent. There are those individuals who are attempting abstinence in order to appease a family member, to save a job, to comply with the legal system, to comply with some medical dictate that requires abstinence so as not to inflame or worsen a co-existing medical disorder, and/or to attempt to learn how to become a controlled drinker. These individuals may experience short periods of abstinence accompanied by long periods of relapse. Usually, these individuals plan a relapse once the crisis that precipitated their abstinence has passed.

Relapse also occurs because the individual is in a relapse mode. There is a saying that relapse doesn’t occur when you pick up the drink. It started a day ago or a week ago when some behaviors or attitudes became more prominent in the newly abstinent individual’s mindset. Examples of this would be: 1.) Failure to fully internalize the belief that an individual is powerless over alcohol and drugs, 2.) The reemerging belief that the newly abstinent individual can return to controlled drinking and drugging, 3.) Continuing to spend time with old drinking and drugging buddies, 4.) Lessening or ceasing altogether one’s involvement in their 12-Step community, 5.) Failure to develop drug-free recreational activities, 6.) Returning to old habits that are connected with one’s prior drinking and drugging.

The fact that chemical dependency is a primary, chronic, progressive, and prone to relapse disease does not me that it can’t be managed. Your son is not to be blamed for contracting his disease, but he is certainly responsible for managing it. The degree to which your son takes responsibility for managing his disease, will determine how successful he will be in negotiating the long and winding road of relapse.


Learn how to prevent and recover from chemical dependency as well as the aftereffects of chemical dependency on you and your family. Read Dr. Frisch’s, Psy.D. series of Recovery books—From Insanity to Serenity.

Pathfinder’s Checklist
1.) Chemical dependency is a primary, progressive, chronic, potentially fatal disease that is prone to relapse.
2.) In the first year of abstinence there are specific stressors that makes an individual particularly vulnerable to relapse.
3.) Protracted withdrawal is a phenomena where the newly abstinent continues to experience withdrawal symptoms up to a year after becoming abstinent. These symptoms may continue to negatively impact one’s mood, cognitive functioning, and physical well-being.
4.) The newly abstinent individual must internalize a set of coping skills that will enable them to remain sober rather than use drugs and alcohol.
5.) Not every person who attempts abstinence does so with the idea that they intend to remain abstinent over the long haul.

G.B.U.

Steve



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