Helping a Patient Through Relapse

Patients in recovery for a substance use disorder are all on an individual journey that does not have a single route or roadmap to success. In addiction treatment, the topic of relapse is one to be grappled with, because it is often a significant part of the recovery process.

The American Society for Addiction Medicine defines addiction as “treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences.”¹ ASAM also contents that evidence-based “treatment approaches for addiction are generally as successful as those for other chronic diseases.”¹

The National Institute on Drug Abuse points out that the disease of addiction is like other chronic diseases with both physiological and behavioral components (e.g., diabetes, hypertension, asthma): it requires continual evaluation and modification as appropriate and even sees similar rates of relapse.²

Even in cases where a person is motivated to achieve long-term sobriety, relapse can and does often occur. Relapse can occur even after lengthy periods of abstinence.³ In many ways, relapse is an expected outcome of treatment, and all members of the patient’s healthcare team should acknowledge it as a part of the recovery process and understand that a relapse signals a need to evaluate current treatment components.³

Relapse After Treatment

Addiction treatment is designed to put patients on a path of change that leads to sustained recovery and sober living. Inpatient and outpatient addiction treatment programs typically increase a patient’s self-awareness and help a patient develop lifelong psychosocial skills to help prevent relapse during the period of recovery.³ Components of an individualized treatment program typically include several components: psychotherapy, pharmacotherapy, case management, participation in self-help groups including 12-step programs, and self-management approaches.

Recovery itself is a long-term and ongoing process—there is no endpoint.⁴ Relapse doesn’t mean that treatment has failed, but it should signal a need for treatment to be evaluated and adjustments considered in order to prevent future relapse and achieve a more positive outcome.⁵

Providers and patients can work together to identify adjustments in one or several components of the patient’s individualized treatment program. Perhaps inpatient treatment is required, or maybe a medication adjustment. Does the patient feel a need to attend to more—or less—self-help group meetings. Is there a need for increasing the frequency of psychotherapy sessions? As with so many aspects of recovery, the solution isn’t always clear but when a relapse occurs it’s important to evaluate the current approach. Recurring relapses may require more drastic measures or signal a return to intensive inpatient or outpatient treatment.³

Relapse Prevention

ASAM identifies ten clinical intervention strategies for relapse prevention. All or some may be incorporated into a patient’s individualized treatment plan and each should be evaluated following a relapse.³

1. Treatment providers help patients understand relapse as a process and event as well as identify warning signs.
2. Identifying high-risk situations and developing effective cognitive and behavioral coping mechanisms.
3. Enhancing a patient’s communication skills and interpersonal relationships to develop a recovery social network.
4. Reducing, identifying and managing a patient’s negative emotional states.
5. Identifying and managing a patient’s cravings and triggers—and the cues that precede them.
6. Identifying and challenging negative thinking patterns, or cognitive distortions.
7. Helping patients work toward a more balanced lifestyle.
8. Considering the use of (or adjustment of) medications in combination with psychosocial treatments.
9. Identifying or facilitating the transition between higher and lower levels of treatment (e.g., residential or hospital-based inpatient treatment, structured outpatient programs, etc.).
10. Incorporating strategies to improve patient adherence to treatment and medications.

Every member of a patient’s healthcare team can play an important role in helping a patient understand the realities of relapse and should support effective relapse prevention strategies (or make adjustments to relapse prevention strategies as needed). Helping patients stay positive and hopeful after a relapse is just as crucial as preventing future relapses and re-examining treatment components or relapse prevention strategies.

Ultimately, when handled well, relapse can be used as a positive and productive step toward long-term sobriety and a healthy future.

References

1. American Society for Addiction Medicine. (2019). Definition of Addiction.
2. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): How effective is drug addiction treatment?
3. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
4. Zweben, A., Barrett, D., Carty, K., McRee, B., Morse, P. & Rice, C. (Eds.). (1998). Strategies for Facilitating Protocol Compliance in Alcoholism Treatment Research.Rockville, MD: National Institute on Alcohol Abuse and Alcoholism.
5. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Principles of Effective Treatment.