Facts About Relapse
For families with loved ones in recovery from addiction, the R word is a very scary word. If you have been to our Family Program weekend, you are probably much less scared than you used to be. I want to take this series to help dispel some of the fears by sharing some facts about relapse, what you as a family member can do to help your loved one prevent a relapse and what to do if it does happen. I will also talk about some general Do’s and Don’ts for the best ways to support your loved one.
So first off let’s start with the most important fact about relapse: You cannot make your loved one relapse. There, of course, are things you can do that are less supportive, unhelpful, or even down right damaging, but ultimately they still have a choice. I will talk about things you should avoid doing, and I encourage you to talk to your loved one to ask what you can do to try and avoid upsetting them unnecessarily. It is also important to recognize that you are human, and will unwittingly hurt them at some point, and they are still responsible for their own actions.
It is important to point out that there is a difference between a slip and a relapse. While some people will say it is all the same, logically anyone can see the difference between slipping up and having one drink or relapsing and going on a three-week bender.
The MOST important factor in any slip or relapse is your response to the event. As with anything, your interpretation of an event leads to your response. So, for example, if your loved one believes that one infraction and they have blown all their progress, that they are a failure, and therefore they may as well binge. This all or nothing thinking becomes a self-fulfilling prophecy which is called the ‘abstinence violation effect’. The problem with this way of thinking is that a lapse has the potential to become a relapse and then a collapse. As a family member of someone in recovery, you can help by not overreacting and helping to keep things in perspective. Most of the time relapse is not the end of the world. The faster they can get back on track the better.
Lastly, a relapse starts well before the person uses. Research shows that a relapse usually starts mentally a week or two before, be it fully conscious or not. It usually has a trigger or several cumulative triggers that can be identified if the person looks back and deconstructs the events leading up to the relapse. A slip or relapse can be a great learning opportunity if the loved one talks it through with a trusted friend or counsellor. I will talk more about this in the next episode when I talk about Relapse Prevention.
In talking to you family members about relapse prevention, I am in no way inferring that your loved one’s recovery is your responsibility. Only they can do their recovery, and only they can ultimately prevent their own relapse. Still, it is important to talk about what you can do in a supportive role.
Last episode I started to talk about how a relapse usually starts mentally well before the person uses; this is sometimes called the Relapse Tunnel. You may already know what I am talking about. You know your loved ones well and you start to notice changes in their behaviour and mood. Maybe they even start doing things that they used to do in addiction, like isolate. It is important to set up good communication guidelines before so that you can address your observations in a supportive conversation that does not come across as nagging or accusing.
During our Family Program we start this conversation between the clients and their family and we encourage an ongoing open dialogue. Your loved one is also encouraged to garner support outside the family because sometimes family is too close and they don’t want to alarm you unnecessarily. The less reactive you are, the less afraid they will be to share with you openly and honestly. So, dealing with your own fears and getting your own support is helpful.
The most important thing to remember here, as always, is that your loved one is the author of his own life and you are the author of yours. So their recovery is their job and you trying to control or meddle is ultimately not helpful. You can’t do it for them, and you will exhaust yourself trying. Experience shows this is true and they do not learn for themselves, and often don’t like your over involvement anyway. If you catch yourself checking up on them or making demands on them, pull back, calm yourself, and remind yourself that only they can live their own life and you need to live yours.
Over and above the coping skills and recovery activities that your loved one engages in, the fact is that in order to be stable, sobriety needs to be more rewarding than drug use. Sobriety is a by-product of a meaningful life. Meaning in life is derived in part from our relationships. So having an authentic meaningful relationship is the most supportive thing you can do for your loved one in recovery.
Like I pointed out in episode one, the fact is the vast majority of people will slip or relapse at least once. So have a plan for yourself and any children that you are responsible for. This, again, is something you will want to set up in advance with your loved one in recovery. Remember from my last series that setting boundaries is not about controlling the other; it is about protecting yourself. Depending on your relationship with them, like if they are your adult child that does not live with you, or if they are your husband and you share a home with your two young children, setting up this plan and boundaries will be more or less complicated.
Part of your communication with your loved one around having an emergency plan may include the work they did on that while here at SCHC. They may share this with you if they think this would be beneficial. In an emergency it may be helpful to remind them of their plan, which could include calling other supports, going to counselling, or calling the alumni support person here at SCHC.
Remember that having a slip or relapse does not mean the person has forgotten everything they learned in recovery, or that they do not care about their family, or that the family did not support them well enough, or that their treatment or counselling was inadequate. A slip or relapse can be part of the process and can be an excellent learning opportunity for the person if they take time to unpack it. For this reason, it is important not to ignore a slip or relapse, this will only lead back to full blown addiction.
Make sure to take care of yourself in this stressful time. Defining and communicating clear realistic boundaries prior will be key. For example, if you share a household with the person, you may set a boundary that there is no substance use in the house and you do not want them to be around you if they are intoxicated. Make sure that you have safe outlet as well, such as close friends or a support group.
We do not have the power to get people to stop their addictive behaviour. Instead, we have the power of our reactions. Often with our reactions, people will be inspired to change. Along with taking care of yourself, some other helpful reactions include:
- Leaving pamphlets out that include sources of support (life preservers) like the crisis line phone #, treatment center phone number, information on recovery, etc.
- Communicating the fact that you know that your loved one is capable of recovery and can have a good life. Send positive, reinforcing messages of hope.
I hope you feel more prepared in weathering a slip or relapse. Next episode I will talk about some Do’s and Don’ts in supporting your loved one’s recovery.
Do’s and Don’ts for Families
It is not easy to be in relationship with someone who struggles with addiction. When they are in active addiction you need to have boundaries to protect yourself and yet still somehow communicate to them that you love them. When they are new in recovery and the trust is still not built back, you have to try and trust them enough to slowly get it back. There is no rule book, no manual, and rarely a clear path. You are best to embrace imperfection.
Here are some general do’s and don’ts:
Where ever possible, allow natural consequences rather than imposing punishment. The overwhelming weight of clinical trial evidence is that lecturing people who have already developed problems is a waste of time. Try to use a strengths-based approach rather than a deficit approach. Encouragement for positive action is proven to help much more than focussing only on the negative. If suffering cured addiction, there wouldn’t be any. Most people have suffered plenty and feel terrible about themselves. They need something positive to move toward.
Interestingly, some research shows that a client’s belief in the disease model of addiction predicts relapse. Here at SCHC we do not subscribe to the disease model and instead take a meaning-centered approach and support them in working towards a meaningful life.
The most important thing you can do to support your loved one is to acknowledge the fact that they are the author of their own life. Whether they are in recovery or in active addiction, this fact remains the same. No one can live someone else’s life for them, so avoid trying to control or rescue your loved ones. Remember that the vast majority of problems in recovery come when one adult starts to believe that he or she is the author of another adult’s life, or when one adult puts his or her responsibility in the hands of another adult.
Through it all, make sure to take care of yourself. Loved ones sometimes lose themselves in the upheaval of dealing with someone in addiction. Take time for yourself, in doing so you will be able to stay centered and make good decisions.
Thank you for joining us for this series, and do give us a call if you need some support.
Also, check out www.canadadrugrehab.ca if you need help connecting to some resources in your area.