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INTRODUCTION

In chronic disorders, such as alcoholism and drug dependency, the danger of relapsing is ever present. For many, the relapse is indicative of complete failure, and it is this belief that makes one feel that attempts at recovery are "hopeless".

Until relapse is understood within the context of chemical dependency, it will remain a de-motivating factor for both the person who is chemically dependent and those who care about him.

DEFINITION

Relapse is largely unrelated to the quantity or the type of chemical substance consumed by the chemically dependent person, and can refer to anything from one "joint", "shot", drink, etc., to a lengthy binge.

A common myth that exists states that "a relapse is a relapse, is a relapse". However, the latter statement can be proved wrong when one examines the different types of relapses.

TYPES OF RELAPSE

The common relapses which occur, after the alcohol/drug dependent has sought treatment are as follows:

1. That relapse which tends to occur within the first few weeks of treatment which is commonly referred to as the WITHDRAWAL RELAPSE.
2. The relapse which occurs after a few months of sobriety (+4 - 6 months) and abstinence, when circumstances appear to be favorable. This type of relapse can be referred to as the GAINING CONTROL RELAPSE.
3. That relapse which occurs in a crisis situation - better known as the CRISIS RELAPSE
4. The relapse related to feelings of frustration, and the inability to express anger and negative feelings. This inability to constructively handle a "Down" results in the re-emergence of feelings of craving which is psychological in nature.
5. That relapse caused by the inability to resist social or peer group pressure to use a chemical substance - for the drug dependent this is related to the difficulties experienced in leading a straight life and the pull of the old Drug subculture and group.

The factors causing the above types of relapses may differ and so may the consequences and implications of each type of relapse differ, but the response to each relapse will probably be very similar. All those who are closely linked to the drug dependent mostly react it with hurt, anger and despair.

Before examining the relapse progress, it is necessary to focus on some of the more common circumstances that could precipitate a relapse.

COMMON PRECIPITATING FACTORS OF RELAPSE

1. The Withdrawal Relapse.
   This type of relapse often occurs within the first two weeks of treatment and is related primarily to withdrawal and an inability to function effectively in the absence of the drug of dependency. At this point in treatment, the drug dependent experiences physical discomfort, a low tolerance for frustration, an inability to face his reality without drugs, and often he feels ambivalent about his decision to abstain from drugs. The loss of his drug usually results in depression.

   It is these factors which prompt him to seek relief and, unfortunately, in most cases the person who relapses at this point, will leave treatment altogether.

2. The Gaining Control Relapse
   It is not common for a patient who has abstained for a few months to relapse after 4 - 6 months in treatment. This relapse is often a subconsciously (or even sometimes consciously) planned one. A common feature of this relapse is that it seldom begins with a binge. It usually presents itself in the form of controlled drinking or drugging for a few days, a few weekends or in some cases even for a few weeks.

   Furthermore, there appears to be no trigger - i.e. if you had to ask yourself "Why?", you probably would not know the answer to this question if your are being totally honest with yourself. Usually, only after the relapse has occurred, would one be able to find a hundred reasons to justify it, but these reasons would probably not have featured prior to the relapse.

   The response of patients and their families to this type of relapse is often one of discouragement - "nothing has been accomplished", "I thought that I was doing so well", and "it is hopeless".

   It is sometimes thought that the relapse occurred BECAUSE the patient was doing so well, and because a great deal had been accomplished. The patient had more than likely regained the respect of his loved ones, he had a good job, his relationships had improved and new friendships had been established.

   In summary, the patient had gained control over his life, and it was this sense of control that made him believe that he now had the ability to also control his intake of alcohol and/or drugs - "I have no reason to drug, so I won't need to go overboard".

3. The Crisis Relapse
   This relapse can occur at any stage in the recovery process, and is usually unplanned - and occurs in binge form.

   In the face of a crisis, an event, or a series of events can prove too much for the individual's coping skills, and he will seek relief from the crisis by drugging (i.e. reverting to his old way of solving problems by opting out of the situation).

   At the point of relapse, it is important to identify and to work through the factor/s, which are causing emotional distress and the relapse.

4. Relapse caused by inability to resist social and peer group influence
   As drug dependents, you will need to realize that you can never afford to be careless. It is no good being only half-aware of the dangers of going to a party or gathering where drugs will be available. You know that it is risky to start drugging or drinking in such a setting, but you think, "you could get away with it because everyone is ding it". Remember, not everyone will have to suffer the same consequences as you, being a drug dependent will have to.

   Always keep in mind the painful memories related to drugging in the past and don't drop your guard and only consider the prospect of fun. Drug dependence is a disease that you cannot fight, so one would rather flee from high-risk situations.

   Now that we have a better understanding of the different types of relapses, and factors and events, which could lead up to a relapse, let us briefly examine the relapse process.

THE RELAPSE PROCESS

After a period of treatment, whether it was voluntary or coerced (i.e. forced) treatment, persons may experience a sense of personal control. The longer the period of abstinence, the greater the ability to cope with situations that were previously avoided by using chemicals.

However, while the overall sense of control may be strong, the person may be making "mini-decisions". These mini-decisions set the stage for relapse, although they appear irrelevant to any decision to use alcohol and/or drugs again. This is illustrated by the case of the recovering alcoholic who just happens to get off the bus at the bottle store each day, rather than going an extra block. Or by the drug dependent who walks past the chemist each day instead of walking on the other side of the road.

All these mini-decisions, or apparently irrelevant decisions, increase the likelihood that an individual may encounter a high risk situation and may set the stage for relapse.

High-risk situations are situations associated with the previous use of the addictive substance as a method of coping.

If the individual is able to cope with a situation, his sense of self-control may increase, as well as the expectation of being able to cope with future risk situation. However, if the individual is unable to cope, he will experience an immediate decrease in self-confidence, and feelings of helplessness will increase, as well as a tendency to give in to the situation.

If a person has failed to cope with a high-risk situation, has a decreased sense of personal power, and believes that drugging will enhance feelings of control, then the stage is set for relapse.

Following the scenario described above, the person may use a chemical substance and might then experience the following:

• The person can longer see himself as a sober drug dependent,
• and he attributes the slip to internal weakness rather than to external circumstances, and as a result, his sense of control over the factors that contribute to his drugging is weakened.

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