Top 5 Reasons Addicts Relapse

Insanity: repeating the same behavior over and over EXPECTING a different result” (C’mon, you know what the results will be). Back in 2008, I found myself in one of my first psychotherapy groups and the group facilitator said, “Look to the left, then to the right, as only one of you will stay sober!”

Over the last 30-40 years countless addiction professionals have attempted to predict treatment outcomes. The reality is, due to the nature of the disease and instability of the addict, outcome studies are rarely accurate and difficult to conduct. I think I’m qualified to answer one of the most common questions that EVERYONE asks; what the prognosis is? What are the percentages? You know what I tell them, “if you do everything I tell you to do and everything the thousands of addicts who have arrested their own demons do, it’s 100%”.

Below are my top five reasons addicts relapse.

1. The addiction landscape has changed

While medicine cabinets filled with hydrocodone and xanax are the gateway drugs (they used to be nicotine and marijuana), we now have a landscape filled with dangerous heroin tainted with fentanyl and other additives. Additionally, most addicts seeking treatment are dependent on a multitude of substances causing cross-addiction and significant chemical imbalance in the brain. We are dependent on using live saving medications like Narcan and Suboxone.

2. Average age of onset Never before have we seen so many addicts under the age of 25 enter rehab. Adolescents are abusing substances at an alarming rate. Unfortunately, it is between the ages of 13-22 that the prefrontal cortex of the brain, the part of the brain responsible for decision-making and impulse control is developing. Alcohol and other drugs stunt the development of the prefrontal cortex leading to impulsivity and poor decision-making. The transition from adolescent to adulthood is a scary proposition for well-adjusted individuals. Add these dangerous mood/mind-altering chemicals into the mix and you have a recipe for disaster.

3. Managed care Insurance carriers “graciously” authorize three days of detox and seven days of residential treatment before politely saying, “we think he can be treated in an outpatient setting”. Really, I mean for God’s sake, after 10 days the person still has traces of the benzodiazepines from detox, they’re not sleeping and their cravings are through the roof!

4. Insufficient aftercare plan The treatment model is incomplete and as a result of inadequate follow up immediately following residential, partial and intensive outpatient treatment, addicts return to their old coping mechanisms. The gap between intensive outpatient treatment and sustained sobriety is a critical factor in the relapse process and it needs to be closed. There is no continuity of care; a case manager hands the client a list of health care providers in their home area, and we expect the 18-year-old to call and schedule an appointment, to join a 12-step self-help support group, to return to school where all the other 18-year-olds are drinking there way through college and to join the work force. Insufficient aftercare planning falls on the shoulders of all parties involved, whereas the next item falls squarely on the shoulders of the addict.

5. Not applying roadmap of treatment suggestions Go to any 12-step meeting and you’re likely to hear, “you’ve got to change old people, places and things”. The fact that the majority of the addicts I treat are from another state is indicative of the need to get away from their triggers. So when I ask them, “What happened”, the majority of the time it’s, “I went home”. I refer to this as “returning to the scene of the crime”. Another warning sign that relapse might be looming is when the addict decides to discontinue anti-craving or psychotropic medications without consulting a physician. It always befuddles me when I hear an addict say, “I don’t want to depend on any medication”. So you have no problem sticking a needle in your arm or smoking crack-cocaine, but you’re unwilling to take an FDA approved medication that will help you cope with cravings or a mood disorder that either exacerbates your addiction, or is exacerbated by your addiction. Most importantly, recent studies have shown that utilizing Medication Assisted Treatment (like Suboxone) have not only saved lives but have long-term recovery of up to 60%.

Honorable mention: DENIAL (don’t even know I am lying). I always say that the disease of addiction is the only primary medical disease where the patient denies having or disease or minimizes the severity of it. CHIEF ENABLER (you know who you are). Usually a family member, friend or colleague, someone who will co-sign their addiction by funding it, cleaning up the negative consequences caused by the addiction, and/or taking care of the addict’s responsibilities. A chief enabler can undo 30 days of therapy in 5 minutes by contradicting the aftercare plan. BALANCE (that thing normal folks do). For many addicts early recovery is all about that, RECOVERY. The most difficult decision of the day is what meeting to attend. Add family, career, and leisure activities and you have a loaded plate!

About the Author

Matthew Koenig is a freelance writer and principal of Last Call Marketing which devotes their efforts to Digital Marketing, SEO and Social Engagement. Concentrated in addiction recovery, Mr. Koenig is based out of South Florida. His sober date is June 10, 2013.