Treatment is Over. Now What if a Relapse Happens?

by
A. Thomas McLellan, Ph.D.

Even effectively treated people with addictions will confront
unexpected situations after they leave a treatment program and return
to their home environment. These situations may produce intense periods
of craving to re-use alcohol and other drugs. Lapse, defined as re-use
of alcohol or drugs at least once following treatment, occurs in at
least 50% of those who complete treatment. The most dangerous period
for lapse is the first 3-6 months after completion of formal treatment.
Relapse, defined as return to excessive or problematic use, is less
common, occurring in approximately 20-30% of those who complete formal
care in the prior year.

It is critical that patients, their families and friends prepare for
the possibility of lapse and relapse. The preparation should include
early detection of a lapse and establishment of steps to keep that
problem from becoming a full-blown relapse. Two sets of activities can
reduce the likelihood of relapse and reduce the severity if it does
occur.

Treatment-Related Preparation

A good addiction treatment program prepares patients to:

• recognize they have a problem that will require continued management and monitoring
• learn
  and practice some of the fundamental skills needed to recognize and
  overcome the urge to use or drink when these situations emerge
• be
  engaged in a continuing care program such as AA and receive regular
  monitoring of substance use through urine screening or breathalyzer
• receive periodic phone calls or in-home visits following care to monitor their recovery

These generic elements of effective planning during treatment are
among the best clinical practices available to forestall lapse. This
planning should involve families so they can better understand the
treatment issues, be prepared to support the recovery plan and be aware
of signs of lapse.

Post-Treatment Preparation

To prevent and contain relapse the family should agree to fully
participate in planned continuing care activities. Families and all
concerned others can take five helpful steps:

• Have copies of the continuing care plan prominently displayed to reduce ambiguity and promote full communication and response.
• Early
  in formal treatment, ask the family member in treatment to describe in
  writing some of the very early signs and behaviors that may lead to
  his/her lapse and relapse. For example, he/she might write something
  like "I will begin hanging out with my friend Jimmy," "I will not do my
  homework" or "I will stop attending AA meetings." As the family member
  undergoes continuing care, regularly refer to these written
  descriptions to monitor the recovery process.
• During formal
  treatment, as the individual thinks about relapse scenarios, ask what
  s/he thinks should be done when early relapse signs emerge. Use these
  words to develop a contract that includes an action plan the family
  will follow when any of these signs surface. For example, s/he might
  write "take my cash and credit cards," or "increase the urine screens."
  Be prepared – before the relapse happens – to take the type of actions
  contracted.
• Receive and display the results of post-treatment urine screens. Discuss any positive results openly and honestly.
• Monitor
  and support changes that are consistent with a drug-free lifestyle. In
  other words "catch him doing something good" and then support it
  appropriately.

Excerpted from:  HBO: ADDICTION: AFTERCARE