Relapse is a common enough occurrence that it shouldn’t be stigmatized as such. While statistics vary by substance and study, generally speaking, 40% to 60% of those who complete addiction treatment relapse and return to use. It’s not a reflection of poor character or a lack of effort; it’s the unfortunate aspect of a chronic illness that impacts brain chemistry, behavioral patterns and the biopsychosocial domain of life.
It’s not so much, “What went wrong in treatment?” but rather, “What can be different during the next attempt?” The reality is that the majority of those who achieve long-term recovery do so by attempting treatment multiple times.
Why First Attempts Fail
A number of reasons exist to explain why someone relapses after their first attempt at treatment. While it’s important to understand why so that there’s a difference made second time around, it also sheds light on the need for further discussion before reentering treatment.
First and foremost is timing. People are often coerced into treatment by various circumstances – a legal issue, an ultimatum from family, potential loss of employment. They’ve gone through the motions – personalized plans, group settings, even exit inventories – and though they completed treatment, they were never really internally on board with the change. If one’s not ready, treatment means nothing. But sometimes, it takes downfalls and pitfalls to get someone ready.
Second, people’s needs aren’t always appropriately matched with the level of treatment given. Someone with an extensive history of substance use and a lack of housing stability might be sent to outpatient counseling two days a week with a small group setting. But that’s not enough support to cultivate positive growth for such an extensive issue. Conversely, someone with a good support system and housing stability might be pushed into a residential treatment facility when intensive outpatient would’ve sufficed with minor disruption for their daily life.
Mental health concerns only complicate the matter and too often go undiagnosed. When someone struggles with depression, trauma, anxiety or bipolar disorder, they turn to substances as the only means to medicate and stabilize their psychiatric symptoms; even if addiction treatment was effective, it wasn’t comprehensive enough to deal with dual diagnoses.
Along these lines is the aftercare gap; many programs do well in intensive settings but poorly with transitional efforts back into everyday life. For example, someone is sent home after feeling confident in their abilities to stay off drugs but within the first month back at work and overwhelmed with stress and triggers returns to use without a coping mechanism or support system.
Treatment the Second Time
Someone enters treatment aware that they’re going to take part in it again – and it’s not always with positive feelings. Shame, frustration and reluctance – if it didn’t work once, why will it work now – are all common emotions met upon reentry. But here’s the kicker: It’s not supposed to look like the first attempt – second chances should ideally be different.
There’s an evaluative element that needs to be assessed more thoroughly. What happened from finishing treatment and relapsing? What events or emotions triggered return to use? Was there evidence along the way that everyone ignored? A thorough investigation into the relapse allows professionals to understand what was missing from the approach the first time around.
This is where choosing a program that has experience with people who enter treatment multiple times matters. Facilities like Rolling Hills Recovery Center in Chester NJ have seen their fair share of patients who don’t get the necessary support the first time around and can evaluate what worked or didn’t and how to build a plan based on specific gaps from before.
The intensity of treatment might also need to be transformed. The outpatient setting might not have provided proper structure for someone who now needs residential treatment in lieu of or someone who finished a 30-day program might need a 60 or 90-day stint instead; research shows that longer time in treatment correlates to better outcomes as insurance and costs encourage shorter time for all involved efforts initially.
Second chance mental health screenings should also be more aggressive. Even if nothing was flagged previously, an added look into mood disorders, anxiety disorders, ADHD or trauma history more often than not shows nuances that need simultaneous treatments; integrated care becomes a more obvious necessity between addiction recovery and mental health needs.
What Changes Upon Second Treatment Attempts?
People enter treatment for a second or third time differently than they did for their first effort. Reduced denial – many people try controlling their use themselves or with limited assistance which fails – precludes some resistance in the initial meetings for those professionals who’ve faced challenging patients before because they’re now willing to do whatever it takes.
Treatment outlines can also build upon learned strategies from before. For example, if someone thrived from certain therapeutic suggestions, those would get amplified; if they struggled in certain areas of resilience, additional resources could be fostered there. Group therapy might have more impact from the start because there’s valuable lived experience that’s not just someone listening – relapse prevention planning becomes more concrete because there’s actual history from which to learn before setting people up for success moving forward.
However, an active shame component must be addressed immediately. People coming back feel like they’ve let everyone down – family, friends, now this treatment team – and while that sometimes is paralyzing, other times it’s useful motivation if harnessed appropriately. Effective programs acknowledge how hard it is for people to come back and champion such efforts as strength instead of failure, allowing people to realize returning isn’t necessarily apologizing but stepping back into a new realm of possibility.
Finally, aftercare planning should be much stronger and specific; vague recommendations about “going to meetings” or “calling your sponsor” aren’t good enough – they need well-thought out transitions covering high-risk situations discussed during previous relapses – even ongoing therapy and medication management, sober living situations and intensive outpatient options for anyone who needs additional support to foster recovery are clearly delineated at this time.
Managing Expectations Moving Forward
Regardless of all this information and research backing improvements for those who enter for a second time, it’s important to recognize that multiple attempts don’t mean recovery is impossible – it just means it takes time to achieve the right combination of intensity, therapeutic involvement duration and companion offerings needed to make it successful for specific individuals.
Other people involved – families – also have their share of obstacles moving forward; it’s exhausting watching someone you love struggle, get help, feel better then use again; boundaries need to be set while compassion takes place – and sometimes family therapy or support for loved ones as patients’ families become necessary – but not optional – for the health of everyone involved through this effort.
Costs also become more pronounced with subsequent attempts; insurance might’ve only approved one round but balks at approving another; out-of-pocket expenses add up as families drain savings when trying to help loved ones get better – with all practical aspects becoming valid – however, much like those who obtain more intensive addiction resources find themselves in desperate circumstances with health issues or legal battles down the line, the cost associated there far exceeds any efforts brought forth in the beginning.
The Bottom Line
Ultimately, relapse after treatment isn’t the end of one’s recovery journey; for many it’s just a chapter along the way – and what matters most is what information can be recirculated from that experience and how effectiveness can be bettered based upon increased knowledge subsequently attempted multiple times.
Every episode offers more information as to what becomes appropriate for certain individuals – from residential care vs outpatient at the start or alcoholism/drug use history versus trauma therapy needs being seemingly paramount at all times or maybe emphasizing combining medication-based mental health approached assessments will make a difference – who knows – but all will become clearer with time through similar approaches.
The willingness to do it again – the ability to reassess what went wrong – and approaching treatment through fresh eyes – and mind – makes those who eventually obtain appropriate resources over extended lives conceivable and those who give up fail – it’s not about getting it right at first – it’s about making it work over time through persistence instead.
