by: Ray Dooley, CASAC
Supervisor, Trinity Lodge, the HalfWay House service of the  
Smithers Addiction Treatment and Research Center 

Relapse is considered by many in the addiction treatment field as being a part of the recovery process. Indeed, studies published in the Journal of Drug Issues (16(1), 107-121) have shown that 54 percent of all alcohol and other drug abuse patients will relapse and 61 percent of that number will have multiple periods of relapse; 47 percent will relapse within the first year of treatment.

In an issue of Social Work (45(2), 38-42) Daily writes that relapse does not occur within a vacuum. There are many contributing factors, as well as identifiable evidence and warning signs which indicate that a patient may be in danger of returning to substance abuse. Relapse can be understood as not only the actual return of the patient to the pattern of abuse, but also as the process during which indicators appear prior to the patient’s resumption of substance use.

It is often thought that relapse prone patients are not motivated to recover. However, Gorski and Miller in their book Staying Sober - A Guide for Relapse Prevention quote a study done at a national relapse prevention center in Maryland that “over 80 percent of the patients had a history of cognizance of their addiction, as well as motivation to follow recovery recommendations. In spite of this, the individuals were unable to maintain abstinence.

            In his book, R.H. Peters presents several personal factors which may contribute to relapse which may be useful in any discussion of relapse:

For many patients these factors negatively impact on their recovery before they can become fully engaged in treatment, and relapse occurs. Consider the difficulty for a patient, after attending and outpatient program, to return to a drug infested environment, besieged by chemical using acquaintances, to avoid using alcohol or drugs. Most newly recovering patients do not have any type of support network, many have become alienated from family and friends, and it takes time to develop new sober supports. Interpersonal skills are seriously lacking in many patients and this too can lead to conflicts, emotional turmoil and relapse.

While full engagement in treatment begins to address these issues, it is a process and takes time. For many it is a question of will relapse occur before the process takes hold and, unfortunately, for many, the statistics show that relapse occurs first.

On the positive side, many patients who do stumble and relapse briefly during the early recovery stage do eventually overcome the obstacles and achieve long term recovery. However, for the patient who has engaged in treatment numerous times and has continued to relapse, the question for the treatment professional becomes what treatment modality is best suited for this patient?

Community Residential Services (formerly known as Halfway Houses) provide an excellent complementary modality for the patient attending outpatient treatment, who has been struggling in early recovery with those “contributing factors” mentioned above. Community Residences provide a safe, sober, structured supportive environment where the patient can address those social and interpersonal issues that may have been negatively impacting his recovery. Free of an unhealthy environment, the patient develops supportive relationships among his peers, learns how to resolve conflicts appropriately and interact with others in a healthy manner while pursuing more intensive treatment for their addiction at an outpatient program.

Community residences also help to significantly reduce relapse potential by assisting the patient in other areas such as:

Community Residences also provide 24 hour staffing, providing the patient with needed support as “mini” crisis’s arise. Evenings and weekends, when patients seem most likely to encounter problems, and the resulting temptations to use alcohol or drugs, help is readily available to them in a safe environment.

Recovery is not a static condition but an ongoing process. Relapse occurs when attitudes and behaviors revert to ones similar to those exhibited when the person was actively using alcohol or drugs. It is by providing this stable “home” environment through which patients are free to “test” appropriate behaviors and attitudes and the ensuing results that enable patients to make the necessary changes in these areas.

Chemical addiction is a disease, and, like many other diseases, there is always the possibility of relapse. The process of alcohol and drug abuse is complex, and is impacted by social, clinical and medical factors. The solutions to the problem of chemical addiction are multi-faceted. Treatment strategies benefit from a relapse prevention component in virtually every case. In order for relapse prevention to work, agencies and systems must cooperate and communicate in their search for the best means of successfully intervening with chemical abusing patients. Community Residences are one modality that should be considered in chronically relapsing patients.

by: Ray Dooley, CASAC
Supervisor, Trinity Lodge, the HalfWay House service of the  
Smithers Addiction Treatment and Research Center 


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