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Why do Clients Relapse After Treatment?

It’s curious that clients relapse after completing an addiction treatment program.  

At the end of treatment, they’ve eaten healthy and nutritious food, caught up on sleep, seen the physician for physical ailments, and exercised. Some have been treated by the psychiatrist for co-occurring disorders.

Clients, themselves, report that they feel less pressure from family and jobs. They say their guilt has eased and others are not getting visibly angry with them. They feel better. Even family members typically remark on how well their loved one looks and acts.

Every client leaves with a plan for what to do after treatment. Many of you took part in creating your post-treatment plan with your counsellor and our alumni support staff. For some, the plan covers what they will do everyday for a couple of weeks or months. It may also offer directions on what to do in various risky situations. It offers phone numbers if they get into a jam and includes supports in their hometown that are easily accessible.

Yet, in spite of all this, research indicates that in the best mainstream treatment programs, about 75% of clients will use a drug (including alcohol) within a year after treatment.

This statistic surprises many people and certainly makes no sense to them. Why would anyone who appears to be living a better life return to the drug? It’s baffling.

So in this blog, we’ll look at some ideas to make sense of how someone who seems to be more confident and committed ends up using.

The Usual Explanations

Older addiction treatment philosophies tend to blame relapse on the client’s lack of motivation. Typically, they say that those struggling in recovery “need to do more research” before they are “serious” about their recovery. It’s even common in treatment centers to hear one client complain that another client “isn’t serious about recovery.”

How valid is this explanation? William S. Burroughs, the famous writer and addict, said in an interview, “No one wants to be an addict.” If that’s true, then it’s difficult to believe that some are not serious or unmotivated. There must be something else going on.

Mainstream scientific programs offer an endless number of reasons why a client relapses after treatment. Perhaps the most famous is that a person in early recovery suffers the most severe cravings. According to some experts who believe that addiction is a brain disease, those who relapse don’t know why because relapse is outside of their conscious awareness. It’s as if the relapse is a knee-jerk reaction to craving the drug.

Other experts argue that relapse is a choice. Perhaps the individual believes that he lives under a dark cloud. His life is a catalogue of failures, bad luck, and victimization. Having quit the drug, he realizes that he is saving money, holding onto a job, gaining the respect and trust of others. Life is good. In fact, life is too good. He knows from experience that disaster is coming. So he chooses the time and the place to relapse, so he won’t get caught off-guard when the disaster happens.

Another explanation from the mainstream is that some in recovery feel uncomfortable when others start expecting things from them. Bosses expect the person to show up on time and not call in Monday morning with the “flu.” Family expects the person to keep his or her word. But nobody expects anything from someone in active addiction.

You’ll notice that these pressures are forces that happen to a person: cravings arising from brain chemistry, fate, pressure from others. In other words, in these explanations, the person is not the conscious author of his or her life.

Action

Last time we mentioned some typical explanations of why only 25% of clients who have completed addiction treatment will be continuously abstinent for a year.

Here’s one explanation from a meaning perspective. The great psychiatrist Viktor Frankl said that action was the key to leading a meaningful life. You can gain all the insight in the world into why you use drugs, but none of this is useful if you don’t do something about it.

When we talk to alumni who have relapsed, they tell us that they didn’t take action. Although our psychiatrist often emphasizes the need for clients to set boundaries with their family, many alumni, facing the real-life situation, back away. The risk is too great. Similarly, many alumni who return to drug use tell us that they knew what they “should” do, but couldn’t get off the couch. Insight is safe; action demands taking risks.

Goal of Recovery

I once asked a client to tell me why he came to treatment. He said, “To abstain from alcohol.” I told him that was a dumb goal. He was taken aback by my comment. But I explained that the real goal of treatment is to figure out how to live a great life. If, along the way, he realized that keeping away from the drug was necessary to achieve this goal, then great.

Viktor Frankl always warned his patients to pay attention to living a full life and not focus on overcoming their depression or whatever it was that they were suffering from. Our psychiatrist also warns SCHC client when they leave SCHC not to focus on staying away from the drug. Their goal is to get a life. If they focus on quitting the drug, that focus will intensify their cravings and distract them.

Still, it’s remarkable how many people after treatment put their lives on hold because they think they have to put their energies into staying away from bars and using friends, dealing with cravings, and practicing relapse prevention strategies.  

Boredom

If you’ve been following our online program, you know that SCHC defines addiction in line with Viktor Frankl, who said that addiction is a response to living a life that lacks personal meaning. Frankl pointed out that the hallmark symptom of this life was boredom.

Other psychologists, such as Albert Bandura, have also highlighted the link between addiction and boredom. And SCHC’s research has shown that the number one reason why alumni relapse after treatment is boredom.

It’s odd that mainstream psychology has paid so little attention to boredom. But if you have noticed yourself being bored, you’ll soon realize that it is one of the most uncomfortable feelings you’ll experience. In fact, boredom is so powerful that you’ll do pretty much anything to get rid of it. And being intoxicated eliminates boredom remarkably well.

It may be that the reason so many people struggle in early recovery is that they’re not pursing a meaningful life. In other words, they get bored and don’t know any other way to handle this than to use.  

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