In Indonesia, the relapse number of addicts who had accomplished therapeutic program and rehabilitation reach 90%. While in United States (California), Profesor George Koob MD, neuropharmachologist, estimated that 80% of addicts who had been on detoxification will take drugs again [1].
Drug addiction, is one of the most difficult conditions to treat. Relapse is possible for anyone with a history of addiction. Both addict and practitioner must be aware of preventing relapse or intervening as early as possible when it occurs. I will review more about relapse since it is one of the most crucial issues in treating drug or alcohol addiction. My experiences in working in some rehabs or social institutions related to drug addiction and having active addict also recovering addict acquaintances has helped me to observe and then describe it in this review. Here also I inserted some statements from addicts so we can understand about them better.
According to Lewis, Dana, & Blevins [4], relapse can be defined as an “uncontrolled return to drugs or alcohol use following competent treatment”. You probably will be flustered knowing that individuals who looks serious with their recovery or had been clean for several years often have tremendous difficulty in preventing relapse. Recent data suggest that relapse can take place even after five or more years of abstinence [3].
Moralistic views or laity on relapse look at the addict as a lazy, irresponsible, or weak willed. But the fact isn’t that simple. Powerful drive forces an individual to use the drug. This intense craving often accompanies situations that provide emotional or circumstantial “triggers” for relapse [3]. From my observation on addicts, craving the drug can replaces all rational thought, such as the desire to be a good parent or even loses their mind and heart. They really don’t care about other’s life! Addicts’ family and best friends usually say that “when she takes drug, she looks unlike the real her” or “he becomes the devil”. It’s not uncommon too for addicts to spend money on drugs when their basic needs aren’t met, even though this makes worse their financial problem.
“When I had to choose between family and drug or girl and drug, sorry but I chosed heroin. That’s true. Funny isn’t it? Even when my parents begged me please until they knelted down, I didn’t give a shit. That’s the evil of drugs.”
“I didn’t care when my mother got icu hospitalized or when I saw my family was crying about my condition, and I didn’t care if my mother couldn’t cook anything because I had sold the kitchen stuffs to buy drug..how stupid me at that time.”
Relapse can be upsetting. Remember that few people sustain sobriety at first attempt[3]. Relapse is a normal part of the process of attaining and maintaining sobriety. But it will be a frustrating and serious case if it happens over and over again.
Relapse shouldn’t be viewed as the evidence that the addicts are incompetent, stupid, or worthless. Instead they are encouraged to understand it as a response to environmental cues that constantly impinge on them. The experience of relapse can provide addicts with the opportunity to learn about their high risk situations or triggers and to identify strategies that they can use to prevent them. This approach can raise self efficacy and then enhance coping skills of addicts [4].
Identifying Relapse Triggers
We can help addicts identify their triggers for relapse. You might start by asking “What happened that led you to use drugs again?” Ask them about common triggers because it can be varied in each addict, which may include working, using other drugs, hearing certain songs, isolation, being around other drug-using buddies, having money available, depression, anxiety, parenting concerns, and others[3].
Many people with addictions minimize or deny the seriousness of drug use. They may perceive drug using as a coping mechanism rather than a contributor to their problems [3]. Formal treatment program should be recommended, no matter how many times they have been in treatment before.
According from the research about relapse among opiate addicts, Unnithan, Gossop, & Strang [5] found high relapse rate had occurred within the first two weeks of the withdrawal program. Unnithan et al. [5] and Thombs [4], mentioned factors those tend to cause relapse, like I attached in table below :
In general, it appears that relapsers evaluate more life situations as threatening than do nonrelapsers [4]. That’s why those who relapse seem to have greater difficulty in coping with unpleasant emotions, frustrating events, and unsatisfactory relations with others. Thombs [4] also stated that the nonrelapsers seem to learn strategies for coping with the problems whereas the relapsers do not, in such a way that I think addicts have to understand and aware about their high risk situation and find the best coping to deal with it so that they can prevent relapse.
Thinking Patterns and Relapse
The behavior, drug taking and alcohol drinking, is only a symptom of a much deeper underlying thought process which begins with perception [2]. Behaviors don’t just happen by themselves. Thought, the mind, produces behaviors as well as emotions, both being positive and negative. So besides strategy for coping with the problems, the addict’s interpretation of frustrating experiences—that is how the person think about himself/herself, others, and the world, is also the key to prevent relapse.
According to Ellis [4],the irrational believe that pain, discomfort, or unpleasantness is unbearable, and that it cannot and must not be tolerated can bring discomfort anxiety then accompanied by the tendency to avoid situations or tasks that may be difficult or painful in some way. The reason is no alternative coping strategy (e.g., cognitive or behavioral) can reduce the discomfort anxiety as quickly and effortlessly as alcohol or drugs can. All other strategies require time to work, practice, and individual effort. During such a period, the addict is experiencing discomfort and susceptible to falling back into the habit of depending on drug or alcohol.
On a daily basis, we hear counselors say to patients, “stop taking drugs or you will die”, or just “say no to drugs” and so many of the other statements that are so prevalent in substance abuse treatment today. Do these statements ever stop anyone from taking drugs? Obviously not. The best way an addict/alcoholic will discontinue substance use, begin their recovery process, and find the hope and peace that they seek, is when they are able to arrive at their own conclusions and begin to change their false way of thinking and develop coping strategies to face their problem. All of that can be obtained through rehabilitation or therapy.
There are many irrational beliefs associated with relapse (self defeating thought). Addicts should alternate those beliefs with the rational and constructive ones. Here are the examples of Model Rational Alternative from Ellis, McInerney, DiGiuseppe, and Yeager [4]:
Marlat and Gordon [4] also believe that recovering addicts often feel deprived of pleasure, enjoyment, fun, and so on and ‘they owe drugs to themselves’.
“If I don’t use drug, I feel empty. I feel life sucks. I can’t stand that. Like you, I also have right to be happy. You can be happy just by making out with your girlfriend or wasting money on cool stuffs, nothing makes me happy but drug. Even my relationship can make me happy, but it isn’t complete yet without drug. That’s the package.”
Then cravings for drug or alcohol tend to arise, and they begin to think positively about the bad effects of the substance. At the same time, they deny or selectively forget about all the negative consequences and often the tendency to rationalize the return to using [4].
“On the last minutes before the relapse, I just thought that it shouldn’t have been for a long time. It should have been just for once and no more. So that it shouldn’t have been that bad, just a bit… When I used drug for the first time, I could control myself. So it should have been easy to control too because I just used a few milligrams. I thought didn’t have to worry a lot…but after all, continued by second using..third using…till unstoppable using haunted my life again and when ‘I woke up’ from all of it, I was already in rehab…again…”
Men are disturbed not by things,
but by the views which they take of them [4].
FYI, if you’re interested to know about Cognitive-Behavioral Approach:Treating Cocain Addiction, you can go to http://www.nida.nih.gov/txmanuals/cbt/cbt1.html
Suggested Readings :
[1] Hukom, Iskandar Irwan. (9 Februari 2008). Kembalikan Canduku. Media Indonesia [producer], Tanggapan Serial Opini Tentang Narkoba. Retrieved June 27, 2008 from http://www.mediaindonesia.com/webtorial/ycab_old/?ar_id=MjY3.
[2] Meyers, Alan. (2009). Preventing Relapse by Addicts and Alcoholics through Perception Therapy. Selfgrowth.com : The Online Self Improvement Encyclopedia. Retrieved June 27, 2009 from http://www.selfgrowth.com/articles/Meyers2.html
[3] Snow, D. & Gorman, M. (July, 1999). Addiction: Working with Relapse. The American Journal of Nursing, Vol. 99, No. 7. Lippincott Williams & Wilkins Stable. Retrieved June 28, 2009 from http://www.jstor.org/stable/3472076
[4] Thombs, Dennis L. (1999). Introduction to Addictive Behaviors (2nd edition). New York : The Guilford Press.
[5] Unnithan, S., Gossop, M., Strang, J. (1992). Factors Associated with Relapse Among Opiate Addicts in An Out-patient Detoxification Programme. British Journal of Psychiatry, 161, 654-657. Retrieved June 27, 2009 from http://bjp.rcpsych.org/cgi/reprint/161/5/654.pdf
One of the addicts out there said,
July 17, 2009 at 4:49 pm
Ternyata ada jg psikolog yg ngerti adiksi