What Family and Loved Ones Should Know About Relapse
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 40.3 million people ages 12 and up experienced substance use disorder (SUD) in 2020 (PDF, 3.8 MB). Of those treated for substance use disorder, the National Institutes of Health (NIH) has reported that 40% to 60% relapse. Due to stigma, relapse is often considered a failure, but relapse, which marks a return to chronic or patterned use, can also be considered an opportunity to improve one’s treatment.
For loved ones, relapse can be scary, but it may be comforting to know that SUD relapse, according to the NIH, occurs at rates on par with relapse for other chronic health conditions, like hypertension and asthma. And, like hypertension and asthma, SUD can be managed with treatment and coping mechanisms, especially if there’s a relapse prevention plan. There are even best practices for loved ones of people experiencing relapse.
Table of Contents
What Is Relapse?
“Relapse is not an event; relapse is a process,” Dr. Joseph L. Smith explains. Dr. Smith, an associate teaching professor at Syracuse University’s School of Social Work, has been working in the field of addiction and mental health for approximately 30 years. In that time, one of the most common misconceptions he’s had to clear up has been about the nature of relapse itself. Dr. Smith emphasizes that relapse “starts well before an individual picks up a drink or drug.”
Before someone picks up a substance again, they return to the patterns of feeling, thinking and behavior that predated their abstinence and facilitated their previous pattern of use. Collectively, this is what’s known as the “three stages of relapse.”
What Are the Three Stages of Relapse?
The three stages of relapse are emotional relapse, mental relapse and physical relapse. These stages go in order but not necessarily in discrete steps. So, someone in the mental relapse stage may still continue to experience emotional relapse.
What Is Emotional Relapse?
Emotional relapse entails experiencing emotions and behaviors that pave the way for future relapse—even if the individual doesn’t want to relapse. To identify emotional relapse, look for changes in self-care and how the individual expresses their emotions.
What Is Mental Relapse?
During mental relapse, individuals simultaneously want and don’t want to return to substance use. This friction has the potential to wear the individual down, increasing the desire to alleviate discomfort with substances.
What Is Physical Relapse?
When physical relapse occurs, the individual actually uses the substance. Some people divide relapse into two stages: lapse, which is the initial use, and relapse, which is unrestricted use.
What Are the Signs Someone Is Experiencing Relapse?
If the signs of emotional relapse and mental relapse are identified, it’s possible to intervene with coping skills and prevent or reduce the severity of lapse and relapse. To help make using coping skills easier, it’s important to not be judgmental or to perpetuate stigma.
- Isolating from friends and family.
- Concealing feelings.
- Skipping support group meetings.
- Attending meetings but not participating.
- Focusing on other people’s problems.
- Expressing resentment about others.
- Taking less care of personal hygiene or appearance.
- Developing poor eating and sleeping habits.
- Posting explicitly or implicitly about substance abuse on social media.
- Sharing rants or appearing impulsive online.
- Craving substances.
- Recalling or becoming reacquainted with people, places and things associated with past use.
- Underrating the effects of past use or romanticizing past use.
- Engaging in internal bargaining.
- Lying to others, even about miniscule things.
- Getting defensive frequently.
- Concocting plans to use substances in a controlled manner.
- Seeking out opportunities to use.
What Should You Do When Someone Is Experiencing Relapse?
When someone is experiencing any of the three stages of relapse, caregivers should keep a few best practices in mind. It can be challenging to provide support and maintain healthy boundaries. This requires allowing loved ones experiencing relapse to employ coping mechanisms and resources that may not work. It’s important to remember that help from others is as important to the caregiver as it is to the person experiencing relapse.
Focus on Self-Care
“A lot of times, caregivers want to focus on and fix and help the individual,” explains Dr. Smith, stressing that, “the focus needs to remain on oneself.” Prioritizing one’s own mental health, progress and recovery are vital for caregivers.
Be Supportive But Not Controlling
Encouragement, support, being emotionally available and being a conduit for connection with others can be helpful. However, it’s equally important to not be controlling or so involved that the person experiencing relapse isn’t able to make use of their coping skills or resources at their disposal, such as group therapy.
Offer Non-Judgmental Encouragement
Being supportive is important, but being judgmental can be discouraging. The additional stress can contribute to avoidant behaviors and a desire to use substances. Being judgemental also perpetuates stigma against those experiencing relapse.
You Can Monitor Triggers, But Don’t Go Overboard
A trigger is an involuntary trauma response to stimuli that are unique to each individual. Triggers can include representations or discussion of traumatic experiences. Triggers can also include things that are seemingly innocuous to others, like scents or sounds associated with the trauma. If you know what someone’s triggers are, you can check in with them after potential exposure. However, it is possible to go too far, such as pouring out all the alcohol in one’s home. If someone is determined enough, they will figure out a way to return to previous patterns of use.
Ask for Help
Sometimes caregivers feel overwhelmed, angry or resentful—these are signs it’s time to ask for help. It’s also an opportunity to attend therapy or support groups such as Al-Anon or Co-Dependents Anonymous, which can help individuals remain connected to others. This also models good behavior for the person in recovery.
Maintain Boundaries
Learning to say “no” is crucial. If it is too hard for a caregiver to say “no,” then asking someone to say it in their place is also an option.
Family Therapy
Family therapy can provide education, strengthen relationships and encourage sobriety. Since substance use disorder (SUD) can have an adverse effect on family members, having a safe space to work on past conflict and resolve hurt feelings can be helpful.
Intervention
An intervention may be useful to get someone experiencing relapse to recognize that they need help. When staging an intervention, it’s important to have a treatment program already lined up so there’s little opportunity to back out of getting care.
Things Caregivers Tell Themselves to Avoid Getting Involved
Sometimes caregivers see the signs of relapse but choose not to get involved. While it may ultimately prove better to not get involved, it may be useful for caregivers to recognize if what they’re telling themselves is one of the common excuses caregivers give to not get involved (PDF, 133KB).
- “They don’t need help.”
- “They can stop whenever they want.”
- “If I say something it won’t make a difference.”
- “They’ll hate me and it’ll just make things worse.”
- “It’ll make people think less of them.”
- “Treatment is too expensive.”
- “I don’t know what to say.”
- “I’m not ready to say anything.”
- “I’ll say something later.”
How Can Caregivers Talk to Loved Ones Experiencing Relapse?
Following Dr. Smith’s advice, there are a few things to keep in mind when talking to someone about their relapse.
Be direct and honest.
“I’ve noticed that we’ve been communicating less and spending less time together.”
Be non-judgmental.
“I’m not mad or hurt. I just wanted to check in and see how you were doing.”
Establish and maintain boundaries.
“It’s okay if you don’t feel like talking or hanging out. I know it’s important for you to do your own thing.”
Provide the space and time to respond.
“I just wanted to let you know whenever you want to talk, I’m around.”
Make plans alongside them.
“If you’d prefer to talk to someone else, that’s fine too. I’ve actually been going to Al-Anon meetings and have found it helpful.”
How Can Caregivers Help Minimize the Likelihood of Relapse?
It’s important to set reasonable expectations when putting together a relapse prevention plan. “Sometimes folks are able to meet those expectations and, other times, they can’t,” says Dr. Smith, adding that relapse is often stigmatized. “Some people equate the idea of relapse with failure, but relapse truly is not failure.” Dr. Smith thinks of relapse more like a speed bump, or an invitation to change direction or do things differently.
To increase the likelihood of the relapse prevention plan succeeding, caregivers can participate in the plan’s construction.
Include triggers, such as potential relapse dates and events. That way caregivers can be prepared for days when the person in recovery may be more likely to relapse, like holidays, anniversaries of deaths or breakups, birthdays, celebrations, etc.
Incorporate known coping methods for likely situations. The list can be specific enough to include a potential trauma response as well as options for mitigation. For example, if someone is experiencing stress they may want others to provide emotional validation, feedback or a distracting activity, depending on the situation.
Write a list of people, places and things that are associated with past use that require boundaries.
Consider a daily or weekly schedule to reduce stressors.
Add resources for social connection and recreation.
Signs a Loved One’s Relapse Is Affecting You
Being a caregiver for someone experiencing relapse can pose a risk to the caregiver if providing care requires too much emotional labor or presents the risk of dangerous behavior. Dr. Smith shares some signs that it’s time for a caregiver to step back.
- If the person experiencing relapse engages in impulsive or violent behavior that puts caregivers or family at risk.
- If the relationship between the caregiver and person experiencing relapse becomes codependent, meaning that one or both of the parties enables problematic behaviors.
- If the caregiver starts giving up on things that were once important, experiencing self-doubt and starting to feel symptoms of depression and anxiety.
- If work performance and relationships suffer, or caregivers find themselves withdrawing socially.
- If the caregiver begins to express frustration, anger and resentment toward the person experiencing relapse.
- If the caregiver experiences a trauma response due to a previous history with loved ones who have substance use disorder.
- If the caregiver experiences secondary traumatic stress, which is stress caused by witnessing or learning about the traumatic experiences of others.
How Can Caregivers Distance Themselves From a Loved One Experiencing Relapse?
There are some best practices for detaching from a person experiencing relapse. With these tips, a caregiver can establish the boundaries they need without necessarily feeling like they’re harming the person experiencing relapse.
- Think about the parts of your relationship you’d like to change.
- In a clear, direct and non-judgmental way, let the person experiencing relapse know your boundaries. Be firm with boundaries once set.
- Consider offering alternatives or solutions to problems in a constructive way. Therapy is one possible suggestion.
- Exit the room or choose not to communicate with them when they are not sober.
- Even though you are disengaging, you can still choose to express concern if you feel your loved one is engaging in dangerous or reckless behavior. And, if you feel it is necessary, you can also contact crisis intervention.
Glossary of Relapse-Related Terms
Using proper medical language for talking about SUD is important because it allows for the assessment of potential risk and treatment. Additionally, there are ways to talk about SUD that dismantle rather than promote stigma. Many individuals use person-first language when talking about SUD. For example, “person with substance abuse disorder” as opposed to “drug abuser” emphasizes the humanity of the individual. AspenRidge Recovery Center provides definitions for the following terms.
Substance: Any psychoactive compound with the potential to cause health and social problems, including addiction. Examples: nicotine, alcohol, opioids, stimulants.
Substance Use: Instances of substance use. As opposed to habitual or patterned substance use.
Substance Misuse: When substances are consumed at high doses or to self-medicate. Example: binge drinking.
Substance Use Disorder (SUD): Chronic or patterned substance misuse, such as chronic binge drinking. SUD is considered a mental disorder because it affects an individual’s brain and impedes their ability to control substance use.
Substance Dependence: When SUD leads to a physical and emotional reliance on a substance.
Citation for this content: Syracuse University’s MBA program online