relapse

You’ve Relapsed on Opiates, Now What’s the Next Step?

Does a Relapse Mean the Treatment Failed?

Of course not. The chronic nature of addiction means that for some people relapse, or a return to drug use after an attempt to stop, can be part of the process.

Opioid dependence is a common relapsing condition.  People do well if they stay in treatment and if they are compliant.  Longer treatment is consistent with better outcomes.  Abstinence rates after completion of treatment vary widely, but between 60-85 percent are back using heroin within 6 months. 

Relapse rates for people treated for substance use disorders are 40-60 percent, compared to 50-70 percent for people with high blood pressure and asthma.  Relapse is common and similar across these illnesses. Therefore, substance use disorders should be treated like any other chronic illness.  Relapse serves as a sign for resumed, modified, or new treatment.

While relapse is a normal part of recovery, for some drugs, it can be very dangerous—even deadly. If a person uses as much of the drug as they did before quitting, they can easily overdose because their bodies will not tolerate their previous level of drug exposure.

Why Did I Relapse?

It is very common for addicts to relapse at least once during recovery and some fall off the wagon several times before getting clean for the last time. Relapse happens for a variety of reasons, but one of the major ones is an individual’s perception of having gained more control and a desire to test it out.

Their thinking maybe something along the lines of “I know I struggled with heroin (or another drug) in the past, but this time I know I can control my  use and stop before the situation gets out of hand.” Other reasons for relapse may include:

  •         Thinking “one last time can’t hurt.
  •         An inability to cope with stress (often caused by conflicts at work, home or within a relationship) without the use of drugs.
  •         Difficulty managing physical and/or emotional pain without the use of drugs.
  •         Substituting one drug for another.
  •         Difficulty addressing triggers (places, people and objects associated with former use) and cravings.
  •         An intentional overdose to end one’s life.

An addiction specialist or another mental health professional can help you develop coping mechanisms.

Key Strategies

According to Therese Borchard, editor at PsychCentral, HealthCentral, and a contributor to PBS.org, there are 7 key strategies to help you recover from a relapse. She reports that these, along with therapy, have helped her get through relapse recovery

  1.   Listen to the right people.  You are really not stupid, ugly, weak, or pathetic. Unfortunately, the person telling you that is probably you.  Affirm to yourself that you aren’t any of those things.
  2.   Make time to cry.  Your body purges toxins when you cry.  Release all your emotions and cry like a baby.
  3.   Ditch the self-help.  Self-help books can be helpful for a person with mild to moderate addiction or depression.  With severe depression and a crippling addiction, you need the help of professionals and specialists.
  4.   Distract yourself.  Do mindless things like word puzzles and reading trashy novels.
  5.   Look for signs of hope.  Occupy yourself with looking for signs that there is hope left in the world.  Whatever that sign may be for you.
  6.   Say yes anyway.  Always say yes to an invitation out.  Don’t isolate yourself.
  7.   Break your day into moments.  Most addicts would agree that “a day at a time” doesn’t cut it.  That’s way too long. Break the day into shorter “moments.” Whatever you feel you can handle.

What are Behavioral Therapies?

Science has taught us that stress triggers linked to drug use (people, places, things, and moods), and contact with drugs are the most common causes of relapse.  Scientists have been developing therapies to interfere with these triggers to help patients stay in recovery. 

  •    Cognitive-behavioral therapy:  This therapy seeks to help patients recognize, avoid, and cope with situations in which they’re most likely to use drugs.
  •    Contingency management:  Uses positive reinforcement such as providing rewards or privileges for remaining drug-free, for attending and participating in counseling sessions, or for taking treatment medications as prescribed.
  •   Motivational enhancement therapy:  Uses strategies to make the most of people’s readiness to change their behavior and enter treatment.
  •  Family therapy:  Helps people (especially young people) with drug use problems, as well as their families, address influences on drug use patterns and improve overall family functioning.
  •   Twelve-step facilitation (TSF):  An individual therapy typically delivered in 12 weekly sessions to prepare people to become engaged in 12-step support programs.  Twelve-step programs are not medical treatments but provide social and complementary support to those treatments.

What Opioids are You Using?

Opioid addiction is second only to amphetamines in terms of illegal drug dependence worldwide.  Interestingly, there has been a shift in the type of opioids associated with addiction.  Abuse of illicit opioids such as heroin now represents a small proportion of opioid abuse. Prescription pain medications, such as OxyContin (oxycodone) and Vicodin (hydrocodone) are now among the most abused opioid-based drugs.

Dependence on and abuse of prescription opioid drugs is now a major health problem with prescription opioid abuse exceeding cocaine abuse in young people.  Opiate dependence is less prevalent in the general population than nicotine or alcohol dependence but represents a severe public health problem because it runs the course of medical and psychosocial dysfunction and high mortality rates.

Depression and Relapse

Opioid dependence is a complicated disorder in which multiple factors interact to influence addiction and relapse.  Negative emotional states such as anger, frustration, depression, and boredom are associated with the highest rate of relapse.  Researchers have found that depression is a significant risk factor for relapse after inpatient detoxification as it may lead to self-medication.  Major depressive disorder may become a conditional cue for drug use during abstinence.

Four hundred sixty-six patients were studied for one year. Every two weeks the patients were interviewed using the Hamilton Depression Rating Scale.  The relapsed and non-relapsed groups were compared. Both showed a high average depression score throughout the one-year of follow-up. But the relapsed group had an average score that was almost double that of the other group.  Very severe depression was seen in more than 16 percent of the relapsed group and was absent in the non-relapsed group. 

The researchers concluded that regular screening for depression is needed during the post-detox period, and timely intervention may prevent a relapse. A study found a 30-50 percent decrease in depression rating score from day one of abstinence to the end of the second week.

What Can be Done to Help Reduce the Risk of Relapse?

A new study by  Dr. Joshua Lee published in the New England Journal of Medicine, scientists report on the results of the first study to look at an approved drug, naltrexone, for treating opiate dependence.  The team of researchers looked at the possibility that an extended-release version of naltrexone, a once-monthly injection, could help those in recovery to stay off opiates. “This buys people some time, it’s an insurance policy against relapse,” says Lee. 

The effects, however, last only as long as the people continue getting the injections. When Lee’s team looked at how the two groups (those receiving the injections of naltrexone and those who weren’t) were doing six months and a year after the last treatment, they found that the differences between the two had disappeared.  To prevent relapse, the injections would need to continue.

While some start on methadone or buprenorphine, eventually many stop taking the daily medications or are interested in finding non-opiate ways to recover, such as naltrexone.

Depending on your situation, reducing your risk of relapse might include the following:

  •  Taking medications for underlying conditions
  • Speaking to a therapist on a regular basis
  • Adopting mindfulness techniques, such as meditation

Can a Phone App Really Help?

Hey, Charlie is a phone app that was conceived at a 2016 Massachusetts Institute of Technology “health hackathon.”  The aim of the app is to help people avoid environmental triggers that might threaten their recovery from opioid addiction.  The app monitors a user’s contacts and location and sends pop-up notifications to caution them about risky acquaintances or neighborhoods.

“People and places can remind you of using drugs and stress you out,” said Emily Lindemer, co-founder of Hey, Charlie.  This app chimes in with a different reminder: recovery.  It helps them keep their sobriety at the front of their minds.”  Even for those who receive medication-assisted treatment, “you live your life doing normal things and you still have to battle these constant environmental triggers,” she said.

What Should I Do Now?

Managing relapse is part of the long-term strategy of drug recovery. This means that the solutions are both immediate and focused on long-term behavioral changes.

Asking for help is an important first step. Call upon your previously agreed on a support network,  friends, and family members Seek medical support. Pick up the phone and call (877) 338-6287 to speak to a specialist. At Granite Mountain Behavioral Healthcare, we understand addiction, relapse, and recovery.

Your Granite Mountain doctor, counselor, or therapist can help you find the right mix of medication and psychological help.  It can take time to find the right mix of strategies; there is no “quick fix” to some of the underlying issues like depression or bipolar disease.   

Because addiction can affect so many aspects of a person’s life, treatment must address the needs of the whole person to be successful. Counselors may select from a menu of services that meet the specific medical, mental, social, occupational family, and legal needs of their patients to help in their recovery.

Our goal is to set you up for success.  You need to believe that you can succeed and transform your life.  Our addiction specialists understand because they have been through it just like you.  Call (877)338-6287, or you can reach out by contacting us here.  

 References:

www.drugbuse.gov

www.jhrba.com/en/articles

www.sciencedirect.com

www.beliefnet.com

www.time.com

www.healthline.comm

www.adf.org.au

Article Reviewed by Gregory Struve

Gregory StruveGreg received a Master’s in Counseling from the Adler Graduate School in 2006. He trained at one of the top trauma and anxiety treatment centers in the world until 2008, when he became a faculty member at Grand Canyon University. From 2011 to 2016 he directed a program that lead the field in terms of innovative treatment of anxiety and trauma. During that time he even made several appearances on A&E’s intervention.

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