Addiction to alcohol, nicotine, and drugs is a chronic disease. Treatment for such dependence can continue for a long time, but the possibility of relapse will still be preserved. Traditionally, relapse is perceived as a return to substance use after a long break. However, Washton and Zweben (1996) note that the concept has expanded and gone beyond a return to previous harmful habits. Relapse is a complex process provoked by certain triggers that cause personality changes and gradually lead an addicted person to substance abuse. Despite the complexity of the relapse dynamics and the stealth of its signs, therapists can help patients prevent it using specific strategies.
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Studying the dynamics of such a regress is crucial for its effective prevention. The risk of disruption is almost constant, but the largest number of cases occurs during 3-6 months after quitting (Washington & Zweben, 1996). Factors that provoke relapse are usually multiple, not just one. Examples of such triggers include events that stimulate a strong emotional response – both positive and negative, cognitive distortions, reminders of periods of abuse, and others.
They activate changes, recognition of which is essential for timely intervention. Experts divided such signs into several categories: high-risk situations, physiological, behavioral, cognitive, and affective warning signs (Washington & Zweben, 1996). Although the indicators and triggers are predominantly individual, the dynamics is similar for the majority of patients.
It is possible to distinguish relapse stages, which form a single chain leading to new substance abuse. First, stress level increases and activates negative thinking and frustration. Then, due to oppression, the patient cannot take measures for self-regulation and, in this way, disrupts the recovery and treatment regime. Quitting the healthy routine provokes a skeptical view of all treatment and then disbelief that getting rid of addiction is possible. Impaired thinking and interrupted processes established during treatment strengthen stress, and the patients become disappointed in themselves. Finally, craving for substances becomes insurmountable, and the dynamics of relapse are completed.
In the early stages of the regress process, patients show signs of behavior and mood change mentioned earlier. The psychologist’s task is to recognize them and intervene in time, which is easier to do if the dependent person is also aware of the relapse phases and signs. Washington and Zweben (1996) note that patient awareness as part of an educational intervention strategy helps identify traps and signs earlier and is likely to prevent complete treatment disruption. Simultaneously, the therapists must maintain a balance in their judgments and think about how exactly the dependent people perceive them. On the one hand, it is vital to encourage progress, but on the other hand, pay attention to the risk of relapse, not forcing the patients to believe that they are weak and breakdown will happen soon.
Such a balance is also essential in handling the “pink cloud” – the euphoria of the first months without substances. It is dangerous because patients enjoying new feelings are not ready for stress and the possibility of relapse. To improve awareness, specialists can use methods to analyze both potential disruption cases and real ones, if any happened. The therapists can also ask about events that have occurred as possible signals at regular meetings with patients, thereby determining their potential for regress.
In conclusion, relapse is not just a return to addiction after treatment but a long process triggered by certain factors. The relapse chain begins with stress creating emotional suppression and, as a result provoking inability to self-regulate. It ends with the patient’s self-disappointment and a new intense craving for substance use. Although triggers are usually individual, they can be recognized, which means that a complete recurrence can be stopped. Not only the therapists’ professionalism plays a crucial role in prevention, but also the patient’s awareness of both the risk of relapse and the course of this process.
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Washton, A.M. & Zweben, J.E. (1996). Treating alcohol and drug problems in psychotherapy practice: Doing what works. Guilford Publications.