2. WHY DO PEOPLE RELAPSE?
• Everyone has their own reasons for relapsing, but for most people in recovery
relapses are prompted by uncomfortable emotions and stressful situations. These
events or feelings are referred to as “triggers,” and much of rehabilitation is
centered around persons with a SUD identifying their personal triggers and devising
strategies of how to avoid and/or manage them.
• For many people In recovery, common triggers include:
• Encountering people they used to use drugs with.
• Going to places where they used to get high.
• Watching people on TV or in a movie abuse drugs.
• Hearing someone discuss drug use explicitly or in positive terms.
• Experiencing a difficult event (breakup, job loss, bereavement, arguments).
• Experiencing extreme emotions (stress, anger, fear, frustration).
3. RELAPSE WARNING SIGNS
• Fantasizing about drugs. Touting the so-called positive effects of drugs can be a red flag
that the person is not serious about recovery.
• Romanticizing past drug use. Glorifying the times spent in active addiction may indicate
that the person is bored in recovery and desires the lifestyle of addiction as much as, if not
more so than, the drug abuse itself.
• Spending time around poor influences. Social support can make or break a person’s
recovery. Recovering addicts that spend significant time around people that use drugs are
nearly guaranteed to fall into temptation and relapse.
• Missing treatment or therapy sessions. Missed treatment sessions may indicate that an
addict’s priorities are shifting away from recovery.
• Justification of moderate drug use. When a person starts to explore whether or not they
can use drugs in moderation, or justifies the use of a substance by saying that it wasn’t
their “drug of choice,” it’s a big red flag that they’re falling off the wagon.
4. RELAPSE WARNING SIGNS
• Engaging in compulsive behavior. Rather than sticking to a balanced schedule of
positive activities, a person on the brink of relapse may just focus intensely on one
area of their life, to the exclusion of everything else.
• Spending large amounts of time in isolation. Being alone makes it even more
difficult for an addict to make positive connections in recovery. It also increases the
chances that they’ll justify using drugs again, and decreases the accountability for
their choices.
• Increases in mental health symptoms. Exhibiting higher amounts of depression,
anger, anxiety, loneliness, lethargy, or general dissatisfaction may indicate that the
person’s sobriety is at risk
5. STAGES OF RELAPSE
• Emotional
• Mental
• Physical
• Emotional relapse is often the first stage of relapse, and it occurs before someone in
recovery even begins to consider using again. The individual usually starts to
experience negative emotional responses, such as anger, moodiness and anxious
feelings. They also may begin to experience erratic eating and sleeping habits, and
their desire for recovery often wanes due to a lack of using their support systems.
These are the initial warning signs that a person in recovery could be entering the
process of relapse, and it is important to recognize them as quickly as possible. This
stage occurs before a person is even aware that they could be in danger of relapse,
and intervening now before they enter mental relapse can prevent the issue from
taking hold.
6. STAGES OF RELAPSE
• Mental relapse is the second stage of the process. This is often a time of internal
struggle for a person in recovery, as part of them wants to remain on the road to long-
term sobriety; however, that part of them is embattled in a “tug-of-war” of sorts with
another side that wants to return to using. There may always a part of a person that
wants to use again, which is why addiction is considered to be a chronic condition. As
this phase of the relapse process progresses, direct thoughts about using eventually
arise, and at this point, it’s very difficult to stop the process. When someone dealing
with addiction decides they are going to use, it’ usually just a matter of time until they
do it.
• Once mental relapse has occurred, it usually does not take very long to progress to
the physical relapse stage. This is the stage that is most commonly thought of when
one hears the term relapse. Physical relapse occurs when a person consumes the
substance, breaking their sobriety.
8. STATISTICS
• During the first quarter of 2020, total fatalities due to drugs are 23% higher than the fourth
quarter of 2019: 127 compared to 103. The estimated total for the second quarter is 132,
with a total of 259 estimated for the first half of 2020. It is comparable to increases being
seen nationally, which are attributed to the effects of the pandemic, including social
isolation, economic difficulty, and reluctance to seek medical attention. Interruptions in
drug supplies internationally have resulted in substitutions and combinations that may be
contributing to additional vulnerabilities to overdose. JANUARY – MARCH, 2020 Marcella
H. Sorg, PhD. Margaret Chase Smith Policy Center - University of Maine
• "The common factor of people who overdose is, they're alone," said Clarke. "So, how do
we find additional ways to create the possibility of connection at people's darkest
moments?“ – Public News Service
• Farley (Well Springs ED) predicts that even more Mainers will need substance-use
treatment this fall and winter. She said she hopes the state will be able to support publicly-
funded agencies like hers well enough so they can continue to provide these community
health services. – Public News Service
9. STATISTICS
• Drug deaths in America, which fell for the first time in 25 years in 2018, rose to record
numbers in 2019 and are continuing to climb, a resurgence that is being complicated and
perhaps worsened by the coronavirus pandemic.
• Nearly 72,000 Americans died from drug overdoses last year, according to preliminary
data released Wednesday by the Centers for Disease Control and Prevention — an
increase of 5 percent from 2018. Deaths from drug overdoses remain higher than the peak
yearly death totals ever recorded for car accidents, guns or AIDS, and their acceleration in
recent years has pushed down overall life expectancy in the United States.
• It looks as if 2020 will be even worse. Drug deaths have risen an average of 13 percent so
far this year over last year, according to mortality data from local and state governments
collected by The New York Times, covering 40 percent of the U.S. population. If this trend
continues for the rest of the year, it will be the sharpest increase in annual drug deaths
since 2016. NY Times
10. STATISTICS
• Looking at data from the National Center for Health Statistics, researchers estimate
deaths from alcohol-related problems have more than doubled over the past nearly 20
years.
• Death certificates spanning 2017 indicate nearly 73,000 people died in the U.S
because of liver disease and other alcohol-related illnesses. That is up from just under
36,000 deaths in 1999.
• Some of the greatest increases were found among women and people who were
middle-aged and older.
• Overall, researchers found men died at a higher rate than women. But when analyzing
annual increases in deaths, the largest increase was among white women.
• Only cigarettes are deadlier than alcohol: More than 480,000 people die each year in
the U.S. because of smoking-related illnesses. Copyright: 2020 NPR
11. COPING SKILLS
• People, Places and Things
• Stress Management
• Relapse Prevention Plan
• Deep Breathing
• Grounding
• Creating and maintaining routines
• Positive support network - 12-steps groups – Sponsor
• Don’t get complacent
• Mindfulness/Meditation
• Connecting to values
12. TREATMENT
• Individual Therapy
• Group therapy – Most evidenced based practice to treat SUD’s.
• IOP – Intensive Out Patient therapy
• Sober Living Houses
• In-Patient Rehab (28 days, 3 months, 6 months, 1 year)
• Detox (short term treatment)
• Peer Support Services/Workers
• MAT
13. PRINCIPLES OF EFFECTIVE TREATMENT
• Based on scientific research since the mid-1970s, the following key principles should form
the basis of any effective treatment program:
• Addiction is a complex but treatable disease that affects brain function and behavior.
• No single treatment is right for everyone.
• People need to have quick access to treatment.
• Effective treatment addresses all of the patient’s needs, not just his or her drug use.
• Staying in treatment long enough is critical.
• Counseling and other behavioral therapies are the most commonly used forms of
treatment.
• Medications are often an important part of treatment, especially when combined with
behavioral therapies.
14. PRINCIPLES OF EFFECTIVE TREATMENT
• Treatment plans must be reviewed often and modified to fit the patient’s changing
needs.
• Treatment should address other possible mental disorders.
• Medically assisted detoxification is only the first stage of treatment.
• Treatment doesn't need to be voluntary to be effective.
• Drug use during treatment must be monitored continuously.
• Treatment programs should test patients for HIV/AIDS, hepatitis B and C, tuberculosis,
and other infectious diseases as well as teach them about steps they can take to
reduce their risk of these illnesses.
