Why Is The Relapse Rate For Addiction So High?

The relapse rate for addiction is apparently around 85% post treatment, which is a very high number. Does it mean the treatment programs are inherently faulty? Or does it mean the patterns, and neurochemistry that develops as a result of addiction, are so complex and ingrained, it creates a powerlessness over the addiction?

Google searches will identify a set of risk factors. The withdrawal period is a very high risk period of time because there are both  physiological and a psychological components that must be managed with caution, care, and dignity for the patient. Some states of withdrawal are life threatening.

We have to assume if there has been a treatment program, the treatment will get the person past the initial stages of withdrawal. The first phase is to detoxify, and in some cases it is a critical period requiring close monitoring, fluid replacement, and gradual reduction, and titration of the offending substance.

In my opinion, individual care plans need to be a part of every recovery program, at every stage of recovery. Detox is an acute care phase, if there is severe dependency on any physiologically addictive drug. Oftentimes there are many drugs within a person’s system, to include street drugs or alcohol, combined with prescription, and/or over the counter drugs.

Other reasons for relapse are underlying mental health conditions, childhood trauma, the addicted person’s associates, and/or partying lifestyle, various triggers, and a false sense of assurance such as “I am okay, have a job, and am not on the streets etc”. The idea the addiction can be managed through harm reduction programs might work for some people, but for many, the addictive substance creates a void that cannot be filled, and there is no way of setting limits on it. Once they go back to it, they cannot control it. They are trying to find a way to fill an internal void with the worst possible solution. They end up feeding a monster in a bottomless pit with a voracious appetite.

Abstinence is the only real way to get free of it. This requires a plan, and a dedicated commitment on the part of the addict. No one can leave it up to the system to cure them. In many cases the system is what got them there in the first place. Not to absolve personal responsibility for the choices one makes, but in order to take responsibility, it must become a personal choice. The system might help the process, but it is not really designed to save people. Therefore the system itself must be navigated to avoid the built in pitfalls, and hindrances to recovery.

Other reasons cited are a lack of support systems, such as family support and counselling. In many cases, there is a sense of hopelessness regarding the future. If a person cannot get a decent job, or develop enough confidence in themselves, it is much more difficult. On the other hand, no one can do it for you. It is a personal and spiritual battle of the heart, mind, will, spirit, emotions and physical body. All these elements of recovery must be overcome by the individual.

On the other hand, if there is over confidence and pride, it can lead to a relapse because after a period of sobriety, the person believes they have overcome it, and do not have to abstain or avoid the substance any longer. There is also a strong inclination to substitute one addiction for another, thus giving way to self-deception. A person my quit heroin for instance, but develop a strong dependency on methadone. They may quit alcohol, and develop a dependency on benzodiazepines, believing they are okay since they were prescribed by a doctor. But the substitutions do not cure the problem. They are more like band aids, and do not lead to a true recovery.

Regardless of how and why a relapse happens, it is likely to take the person into the same patterns, or often into an even deeper addiction than ever. Some people believe relapses are part of a process, and to be expected. However, relapses are really quite dangerous. If a person has a relapse, they should not beat themselves up over it, but get back on track as quickly as possible. They should also carefully reflect on what caused the relapse, so they know how to avoid the triggers or pathways that lead to relapse, especially the dominating emotions prior to a relapse.

One of the main dangers of relapses is the fact the person’s tolerance has changed. Therefore they might think they can take the same amount of a drug as they did prior to the period of abstinence, and overdose. Or they might start using again, and manage to control it for awhile, and then rapidly spiral out of control.

The causes or reasons for relapse are widely varied and complex. Many people are simultaneously caught up in addictive type romantic relationships that create emotional upheaval, dependency, and a loss of self control. They might mistake this roller coaster type relationship as love or support, when it is part of the damaging cycle they are in. Some people believe they can rescue others, when they are not intrinsically stable themselves. Relationships can be toxic, with extreme emotional dependency, thus contributing to the cycle of addiction.

I believe the locus of control must come from within. Therefore those who make a decision to quit, without court orders or ultimatums, have a better chance of recovery. Healthy boundaries in relationships must also be learned or established.

In addition, there is a strong spiritual aspect to addiction. This requires a realization that we cannot escape or overcome these patterns on our own. It may seem to be a contradiction to say the locus of control must be an internal driving force, while simultaneously admitting we cannot overcome addiction without accepting God, and the salvation offered through Christ. But the two definitely go hand in hand.

Forgiveness is key to overcoming any kind of bondage. So often people deny or reject the term sin, and yet all addicts have a great deal of shame. The key is to differentiate what the sin is, and seek forgiveness from Christ through sincere repentance. All people need to be forgiven, so it is not only the addict who sins. But to figure out how to get off the destructive pathway, we have to recognize what is destructive. The ability to forgive oneself follows true repentance. It establishes an ability to develop self control, and contributes to a greater understanding of the cause of the deep rooted shame.

People do not like to refer to the addictive lifestyle as sin, because we live in a society that does not want to recognize or identify what sin is. Therefore it makes it much more difficult to repent, and turn away from the things that create an entrapment, and bondage into certain patterns and lifestyles.

There does have to be a substitution of patterns toward more positive daily activities. The addict has to carefully choose what they can do, and what they must avoid. There has to be a way to establish purpose, motivation, and feeling better. In fact, I think feeling better is a very strong motivator for people, and should always be kept at the forefront for all those who are recovering. No more roller coasters, because after awhile the downs are too deep, and the efforts to get the high, just does not pan out any longer. It turns into a cycle of despair. Normal might be boring, but at least it is not agony.

To be free of the bondage, as well as to feel better, are the key objectives. However it is important to be fully aware, once the abstinence is achieved, that it may take some time before a person feels better. The entire neurochemistry has to be reconditioned. This includes restoring natural levels of dopamine, serotonin, melatonin and gut bacteria, to name just a few. Even normal sleep patterns may take months to settle into.

It seems the expectations in many recovery programs might not be realistic, therefore it is easy for people to become discouraged, which creates a big risk for relapse. I think a person has to realize recovery is a long term change, with incremental stages of wellness. Some of the ads we see, show a glowing radiant person standing on the top of a mountain, with claims of being three months clean and sober.

There should be a realistic awareness that there will always be ups and downs. Ecstatic happiness is not going to be the normal state of sobriety, no matter what we do. In fact, peace and purpose in carrying out normal daily activities is a better indicator of achieving wellness in every day life. There is joy in little things. Euphoria is short lived, which means the rest of the time, is where we spend most of our time.

Overall, each person has to develop a plan, along with strategies to improve mood, and neurochemistry, while acknowledging that it will take time. It also depends on the length of time a person was steeped in the addiction, and the depth of the addiction, as well as what range of substances affected the bodily systems. Each recovery needs an individual self care plan.

One key element is the fact that for all people, some days are better than others. To avoid depression, certain things like diet, fresh air, and exercise do wonders. But everyone of us goes through difficult times, and all you can do is alleviate the stress through the various strategies for self care, and wait it out. Prayer is very helpful for those who believe in God. Our entire society has become dependent on quick fixes, and the notion that depression or sadness is a mental health disorder. It is not always a mental health disorder. In fact, there are often many reasons for feeling sad. We cannot expect to go through life without experiencing the full range of human emotions.

The challenge is to be able to recognize what is causing the sadness, and what changes, or actions to take in order to alleviate it. If a person is sad because a family member died, it is an understandable and justifiable sadness. Grief is one of the most difficult types of sadness to overcome. Addictive substances exacerbate grief, and create a vulnerability for those who go through it.

In some cases grief can be managed fairly well, if the loss does not completely upset the foundational stability of a person. But it is a very traumatic and tumultuous period for those who do experience the loss as having the rug pulled out from under them.

To help identify some of the vulnerabilities related to addiction and relapse, grief is high on the list. Also past and present trauma, to include psycho-social trauma, as well as physical trauma. Many people inherit an addiction by adopting familial patterns, or from early trauma. And others fall into addiction as a result of surgeries or traumatic injuries.

Addiction is primarily about escaping the pain of living. Paradoxically it creates an increase in the cycle of pain, and the temporary escape is like a swirling vortex, and worsens by the day. It invites many serious risk factors into a person’s life that can easily end their life. The risks for the addict are increasing by the day.

Recently I read about a young 19 year old man who was overall quite healthy, worked in a stable job, and had good family support. Tragically he died of a fentanyl overdose by taking what he thought was a single Percocet pill. He grew up and lived with his family in a town close to the Mexican border. It was not uncommon for people to go to Mexico for the day with a few friends. While there, he went into a legitimate pharmacy, and bought a bottle of Percocet because it is like an over the counter medication there. You can understand why he would have thought this would have been a safe way to make the purchase, regardless of his reasons for buying the drug.

After spending the day in Mexico, he went home, picked up some take out food, and later on, when he went to bed that night, took one pill from the bottle. The next day when he did not show up for work, his parents were alerted, and went to check on him. They found him blue and unresponsive in his bed. He had died during the night.

It turned out the Percocet he had purchased was laced with fentanyl. His parents found the bottle, the receipt, and counted what was left in the bottle. They knew he had taken just one pill. He could not have known it was laced with fentanyl, and nor was he a drug ravaged addict. He might have had a sore back, or he might have had trouble sleeping, and thought this would insure a good night’s sleep. Who knows for sure? However, the fact a pharmacy open to the public, would have mislabelled Percocet on the shelves when it is actually laced with fentanyl, is a shocking realization for all those who travel to Mexico on vacation, or order pills online etc. The single bottle of Percocet he happened to purchase, had enough fentanyl to kill thirty or more people.

Many people remember the scare a few years ago when an over the counter pain medication was contaminated with cyanide. I think it was some kind of copy cat murder, or diversion for someone who wanted to get away with a targeted murder. But at least the tampered drugs were immediately pulled off the shelves, and it was considered to be murder. I don’t know if there is an investigation when this type of thing happens in Mexico, but it should be considered to be murder too. The offending pharmacy should be shut down.

It just made me wonder what scope and potential there is for such tainted products to be distributed through other mainstream channels. One would think a pharmacy in any country would not have products on the shelves that are incorrectly labelled, and can kill a person in a single dose. The loss of life  due to overdoses is staggering, which means the world has an exponential amount of grief to cope with, as a result of drugs.

We are living in perilous times. I see young people on the street who exhibit the same kinds of brain damage you see in long term care facilities where people have had traumatic brain injuries, strokes, and organic brain syndromes. It is just tragic to see someone in their twenties who can hardly walk, or speak, or take care of themselves. So many of them have spastic and permanent movement disorders as well. If they spill the contents of their backpack, they cannot manage to pick the items up, and put them back into the pack. The loss of function is debilitating beyond words.

Recently the system has added another very worrisome drug. The pharmaceutical and health care industry is starting to promote ketamine as a treatment for depression. The long term results of such a treatment cannot possibly be good. Ketamine is an anesthetic drug used in hospitals, and more often in veterinary medicine. It is meant for occasional use only in a monitored and controlled environment.

As a street drug ketamine is unpredictable and addictive, leading to dissociative experiences, hallucinations, and is not meant for street use. There is no way of knowing the long term effects, as it has not been prescribed as a treatment for depression until recently. I was gobsmacked when I read it was being prescribed as a nasal spray for depression.

One university research article claimed ketamine could rebuild the cortex and neuronal pathways of the brain. What a croc of nonsense, no different than when they claimed opiates were not addictive. So many university studies are based on research funded by pharmaceutical companies. In the future, they are far more likely to discover the long term use of ketamine destroys the cortex of the brain, as opposed to rebuilding it. To claim it enhances neurochemistry or synapse communication is insane.

They used to think and claim SSRI’s increased serotonin, or at least many people thought so. Now they admit they simply increased the rate of circulation of serotonin in the brain and central nervous system, which eventually depleted it, and caused a flat affect, worse depression, movement disorders, and various other psychological deficits. SSRI’s often cause extrapyramidal side effects, and suicidal ideation. Ketamine, in my opinion, will be a hundred times worse in the long run.

They want to give other hallucinogenics to treat mental health disorders. When a person has hallucinations, it is considered to be a psychotic episode. Hallucinations are when a person hears voices or sees things that are not really there. If a person has hallucinations, the doctors and pharmaceutical industry are likely to promote anti-psychotics to treat the psychosis. So you can already see how easily a destructive cycle begins. Then the anti-psychotic drug causes a severe movement disorder. So they give an anticholinergic drug to offset the side effects of the anti-psychotic drug. You can see how one ends up getting a chemical soup for breakfast, lunch and supper.

It is not difficult to see how pharmaceutical and prescription drugs have become a leading cause of death. We should all be very cautious, and steer clear of psychotropic drugs period. They tend to treat side effects by giving more drugs.

In many ways, we are navigating a system of pharmaceutical landmines. Step on on one, and it might go poof into a little cloud of smoke. Yet if you step on another one, it might blow up in your face. It is like a game of Russian roulette, and it is no wonder the trust in the health care system is becoming increasingly sketchy. The profit motive supersedes our brains, our minds, our health, and our common sense. The more people they can get addicted, the bigger and more steady the profit becomes. The casualties are piling up in the morgues.

When it comes to medication, it is buyer beware. If medication is legitimately needed, we should all do in-depth research before taking it, and create a plan to get off the drug as soon as possible. All substance abuse starts with the use of the substance, with a false sense of security. The best thing we can do for ourselves, is to try and avoid the trap in the first place.

If we do fall into the drug trap, get out of it as fast as possible. We are wise to make a confirmed decision to avoid the pitfall like we would avoid quicksand, or landmines, or climbing down a dark mine shaft, or walking in front of a train. Some of the negative outcomes are insidious, and others are rapid.

Either way, addiction is a death trap. For those who are steeped in addiction, they are palliative, and need care like anyone else who is palliative. The war on drugs is actually a war on the individual for profit. The entire scope of it is so blurred, it has blinded us to the dangers. Relapse used to be something to shrug off as part of the journey. Now it is like losing the trail completely, and stumbling back into a pit of crocodiles.

Copyright Valerie J. Hayes and Quiet West (2023). Unauthorised use and/or duplication of this material without express and written permission from this blog’s author/owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Valerie J. Hayes and Quiet West with appropriate and specific direction to the original content.