Why is Relapse so Common?
Relapse is a persistent and contentious problem for drug and alcohol rehabilitation programs. Going through treatment and then turning back to the substance is seen as a failure, either of the individual who relapses or of the treatment itself. It’s hard to determine whether these assumptions are true, particularly because of the various competing explanations and the fact that it is quite widespread. Finding out about how common it is and the various explanations for it can give you a better understanding of relapse and the various factors which may play a part.
How Common is Relapse?
The rate of relapse varies depending on the specific drug being abused, but it is generally around 40 to 60 percent. In cases of opiate addiction it can be as high as 85 percent. These figures appear shocking at first because we inherently expect treatments of any type to solve the problem, but considering it in the context of other medical conditions gives you a better idea. Relapse rates for asthma are between 50 and 70 percent, and for type 1-diabetes they’re between 30 and 50 percent.
The Explanations: Addiction is a Disease
One extremely common school of thought is that because addiction is a disease it has relapse rates like any other. As you can see from the data above, addiction relapse rates are comparable with those for other chronic diseases, so you could argue that they aren’t anything to be surprised by. Diseases require consistent intervention to be sent into remission, and so does addiction. Perhaps if some future researcher develops a magic pill to cure addiction, then the relapse rates will drop, but now, sadly, there isn’t too much we can do about it.
Identifying risk factors can help reduce the likelihood of relapse. These can be both internal and external, so avoiding them entirely isn’t usually possible. Internal risk factors can include things like stress, depression, anxiety disorders and a genetic pre-disposition. External risk factors are more hard to define, because they vary wildly from person to person, they could include things like driving past a corner previously used to buy drugs or a chance meeting with an old friend you used to take drugs with. Learning to deal with these situations is the only way to avoid relapse.
The Explanations: Lack of Scientifically Proven Treatments
There are some people who argue that the drought of scientifically verified treatments used in psychology as a whole is to blame for the high rates of relapse. Some psychologists have rallied against what they perceive as an anti-science bias in the treatments used. They list some absurdly named treatments such as chaotic meditation therapy and dolphin-assisted therapy to back up their arguments, but they really lay the blame on the myriad forms of psychological therapy currently in use. If someone struggling with addiction isn’t given effective treatment, relapse is obviously quite likely.
They suggest that rigorously studied and therefore verifiably effective treatments like cognitive behavioral therapy should be used more widely to reduce the relapse rate. Results of research into cognitive behavioral therapy have been very positive across a wide spectrum of conditions, and it has also been specifically shown to help substance abusers. It’s also backed up by neuroscience, which means the mechanism by which it works is clearly understood.
The Explanations: Wanting to Change
Another potential explanation for the current relapse rates, espoused by harm reduction psychologists, is that short term abstinence-based treatments aren’t effective. They say that forcing abstinence onto people who don’t necessarily want it will likely be met with resistance, and relapse will follow. Research into the reasons cited by alcoholics for their recovery found that people who “hit rock bottom experienced a traumatic event or had a religious or spiritual epiphany were the most likely to remain sober. This appears to back up the claims, because those three events would logically bestow a true and lasting desire for change.
Their approach is to neither condemn nor condone substance abuse. Instead of making a moral judgment about your use, harm reduction practitioners respect your choice and don’t even mention abstinence unless you bring it up. They provide support if you want to reduce or otherwise manage your use, but don’t assume that abstinence is the goal. If it is, they will do everything they can to help, but if it isn’t they focus on reducing the risks associated with use. For example, they provide clean injecting equipment to heroin users to reduce the risk of blood-borne viruses, and advocate methadone management as a more accessible way of getting clean.
The important lesson to take from all of this is that there isn’t a clear explanation of why relapse is so common. The disease approach claims it’s part of the recovery process, cognitive behavioral therapists lament the lack of science in addiction treatment and harm reduction psychologists think that it’s all about the individual’s desire for change. Instead of getting bogged down in the disagreement, take the positives from each. Work out your risk factors and learn to manage them, make sure you’re receiving effective treatment and at the very least, work to reduce the risks associated with your use.