5 Reasons People Relapse After Years of Sobriety

I have received phone calls and emails following the news of Philip Seymour Hoffman’s death and an outpouring of comments, shares and likes on the status update I posted on my various social networking sites:

Rehab and sobriety at 22; relapsing after 23 years clean; drug detox treatment in 2013 – died of an apparent overdose, “The syringe was in his arm,” quoting from Kiki Von Glinow’s article linked below.

Tragic, tragic, tragic and all the more reason we must band together to shatter the shame, stigma, denial, misinformation and blame and truly understand the hallmarks of the brain disease of #addiction - one of which is relapse.

May he rest in peace…

http://www.huffingtonpost.com/2014/02/02/philip-seymour-hoffman-dead-dies_n_4713623.html

The responses were typical of those I’ve heard over the years when similar tragedies occur – most of which do not involve the rich and/or famous. They range from deep, deep sadness to anger at the disease of addiction to fear it could happen to their loved one to incredulousness – “how after 23 years clean?” – to this one, “Sorry, I quit buying the PC climate of ‘poor me, it’s someone else’s fault’ BS a long time ago. The only person responsible for this man’s death is the person that stuck the needle in his arm.”

So I decided to use this post to share five key reasons a person relapses – even after decades of sobriety – and the 21st century scientific concepts that can counter these reasons.

With 21st Century brain and addiction-related science, we can help people understand why a person would relapse after years of sobriety. When we understand, we can better prevent.

With 21st Century brain and addiction-related science, we can help people understand why a person would relapse after years of sobriety. When we understand, we can better prevent.

Not Understanding the Basics of How the Brain Works

Unless you understand the basics of how the brain works, it’s difficult to understand, let alone appreciate, how drugs and alcohol chemically and structurally change the way it works, which in turn changes the way brain cells communicate with one another, which in turn changes a person’s behaviors. When a brain has crossed the line from substance use to abuse to dependence (addiction), that person’s brain is no longer their own – meaning the brain they had before their addiction. [This is not to say they can't get it back, but to do so, they must treat their brain disease.]

For some of the scientific concepts to counter this reason, please check out:

Here’s to Neural Networks and Neurotransmitters: Keys to Brain Health

Understand Brain Maps | Change a Habit | Change Your Life

Not Understanding Relapse as a Hallmark of This Brain Disease Which is Why a Person Might Relapse After Years of Sobriety

By it’s simplest definition, disease is something that changes cells in a negative way. Addiction changes the way cells in the brain communicate, which is what makes it a brain disease. The concept of embedded brain maps (shared above), the characteristics of this disease (physical dependence, cravings, tolerance and loss of control) and the nature of relapse with any disease – but especially a brain disease like addiction – help counter this reason. The science now shows that relapse is a sign treatment has failed, that it needs to be modified. For more of the scientific concepts, please check out:

Understanding Relapse

Why Addiction Relapse Can Be Stronger Than the Determination to Stay Clean

Why Addicts | Alcoholics Lie, Cheat, Steal

Addiction Relapse – Do You Have to Start Recovery Over from Day 1?

Not Treating the Entry Points to One’s Disease Nor Understanding What Constitutes Effective Treatment

Typically people – addicts, alcoholics, siblings, spouses, close friends, in-laws, co-workers, children, law makers, the criminal justice system – in other words, most of society – do not understand the disease, nor do they understand what causes it. Addiction is a developmental disease, meaning a person is not born an addict | alcoholic. Addiction starts with substance abuse chemically and structurally changing the brain, making the brain more susceptible to the five key risk factors for developing the disease: genetics, mental illness, childhood trauma, social environment and early use.  All five may also cause or influence brain changes in their own right.

Why Do Some People Become Addicted?

When you don’t understand the disease or its causes, you have a much harder time treating it. So, for example, if you don’t’ treat a person’s mental illness (depression, PTSD, mental illness) at the same time you treat their addiction, the mental illness may be the brain’s trigger to use the substance it found so soothing in the beginning.

21st Century brain and addiction-related research now shows that many “things” can help with brain function recovery (and therefore with treating addiction), including behavioral therapies, medications, effective co-occurring disorders treatment, nutrition, exercise, sleep, mindfulness practices, different treatment protocols for adolescent addiction vs adult addiction, 12-step and non-12-step programs, a strong, long aftercare program (in other words, detox and rehab are just the beginning – the brain is not healed in 28 days), and so on. But the most important finding is the overarching concept that treating addiction means treating the brain and that is complicated, and it most often requires a combination of treatment protocols because you are healing that person’s brain.

Addiction and the Brain’s Pleasure Pathway: Beyond Willpower

National Institute on Drug Abuse (NIDA) > Principles of Effective Treatment

Not Understanding the Power of Stress to Trigger a Relapse of the Disease

Stress is such a brain changer – truly. Stress, such as that which we experience on the job, raising children, in relationships, during career changes, after a sports injury, during a divorce, coping with secondhand drinking, after a traumatic event…, activates the brain’s fight-or-flight stress response system. One of the things that can give a person a sense of calm when under stress is using a drug or drinking alcohol. Why? Because the drug and alcohol chemicals work on the brain’s pleasure/reward pathways, the pathways that make the brain (the person) feel good. Understanding that stress can be a trigger to use, can help one take necessary steps to reduce and/or minimize it.

How Modern Lifestyles Activate Ancient Stress Responses

Growing Up With Toxic Stress or Addiction and Its Long-Term Impacts

Stress and Addiction

Family Members, Friends, Co-Workers and Society as a Whole Not Understanding all of the Above

The more we can educate, share, talk about and incorporate this kind of information into our belief and action systems, the better able we will be to support one another, to treat addiction and to prevent one of its key hallmarks, relapse. You see, if a family member, for example, understood brain maps, they’d understand any use of a substance, such a Vicodin prescribed for pain following a car accident, is cause for concern, and that it is okay to insist the doctor know about the addiction, that the prescription use be monitored and the duration of dose be very limited and delivered by someone other than the addict in recovery. Or a teacher observing a child acting out in school would understand the behavior is a possible symptom of the chaos and trauma going on in their home with a parent’s untreated addiction and have received training in how to gently screen for that, with a school administration also trained on the new ways of handling “disruptive” students, the child could be helped before s/he becomes labeled a “problem.” Or a county corrections department rehabilitating prisoners incarcerated for nonviolent, drug-related crimes would have trained clinical staff who incorporate clinical evaluations that solidly screen for addiction, mental illness, childhood trauma and genetic influences based on family history and then treat the whole person and the whole problem, including their family members to whom they will return, as part of the rehabilitation process.

Most definitely, this is very pie-in-the-sky, but hey, we didn’t send men to the moon in 1969 after just 9 short years of preparation without a dream, followed by scientific discovery, funding opportunities, the collaboration of agencies and brilliant minds and the backing of everyday Americans who saw the importance of space exploration. When it comes to addiction, we’ve got the scientific discoveries and the brilliant minds and are gaining when it comes to collaborations amongst agencies and securing necessary funding sources. But, our biggest challenge is getting the backing of everyday Americans to embrace the fact that addiction is a chronic, often relapsing brain disease that can most definitely be treated, giving the person with the disease a lifetime in joy and recovery. That’s when we’ll shatter the shame of this disease and it will fall into rank and file with other diseases. That’s when we’ll be able to cite the science to counter the reasons why people often relapse after years in sobriety.

To this end, I’ll leave you with one last link:

Shatter the Shame of Addiction

Lisa Frederiksen

Lisa Frederiksen

Author Speaker Consultant Owner at BreakingTheCycles.com
Author of nine books and hundreds of articles, Lisa Frederiksen is a national keynote speaker, consultant and founder of BreakingTheCycles.com. She has spent more then a decade researching, writing, speaking and consulting on substance abuse prevention, mental illness, addiction as a brain disease, dual diagnosis, secondhand drinking | drugging, help for the family and related subjects – all centered around 21st century brain and addiction-related research. Her clients (some as far as Kenya, Slovenia and Mexico), include: individuals, families, military troops and personnel, U.S. Forest Service districts and regions, medical school students, businesses, social workers, parent and student groups, family law attorneys, treatment providers and the like. Visit www.BreakingTheCycles.com for details. Please feel free to call Lisa at 650-362-3026 or email her at lisaf@breakingthecycles.com.
Lisa Frederiksen

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  1. Thank you, Lisa, for seizing this important time for beating the drum of awareness. My hope is that folks will welcome education as a way to make sense of what has been so difficult to understand about addiction. The best we can do is to persist. The more understanding, the less stigma. The less stigma, the more people in need will seek help and treatment. Thank goodness insurance companies can no longer discriminate against folks with this brain disease. Getting needed support will become much more accessible.

    • Thank you so much for this Shelley, and I love your point,”The more understanding, the less stigma. The less stigma, the more people in need will seek help and treatment.” I really appreciate you sharing this post with your clients and followers, as well.

  2. Thanks Lisa – very timely and definitely important. It strikes me that we aren’t doing after detox care worth a &%$#! So many people OD after they have been in rehab for 28/30 days, and we KNOW this is a very vulnerable time. More people needs to read article like this, and I will do my part to share it. As always, thanks so much Lisa!!

    • Thank you, thank you, Leslie! It’s complicated but so much easier to understand when we understand the science behind all of this. I really appreciate your help with sharing this article.

  3. You have written a very informative post here, Lisa, at a time when many are asking questions, not understanding and passing judgement on a disease that needs to be brought in the limelight. It was interesting that right after the news report about Philip Seymour Hoffman’s death, there was a mention about a new campaign that will be starting on TV to encourage kids to not smoke. While this is definitely needed, why do they not do this same kind of thing for addiction awareness and prevention? It doesn’t make sense that this isn’t being blasted from the highest rooftops. They have the ability to turn this around, and I continue to wonder what they are waiting for. Thanks as always!!
    Cathy Taughinbaugh recently posted…Is Your Child a Chameleon?My Profile

    • You are so right on, Cathy!! And as we both know, early abuse (while the brain is going through key developmental stages – especially ages 12 – 20) is one of the key risk factors for developing the disease. I think they need to move away from “just say no” to focusing on the brain and how it interprets and wires (develops) because it’s such a Catch-22. The part of the brain that drives risk and turning to one’s peers develops first – the part that is the brakes on these networks and that can reason through why waiting is so important for longterm brain health doesn’t’ even start to develop until around age 16 and takes until 22 for girl and 24 for boys. But I know you know this… I just tend to get revved up about it. Thanks so much for your comment and all you do to help parents better understand what’s involved and how important it is to effectively intervene.

  4. Definite pattern here, Lisa. Let’s see – out of the five reasons, we have four “Not Understanding’s” and one “Not Treating” (which is often a manifestation of “Not Understanding”). Is it any wonder tragic relapses occur? Certainly, the addict has first responsibility; however, I don’t believe we can excuse family members, friends – society as a whole. I’m thinking in most cases the “Not’s” don’t nearly as often apply within the realm of, say, cancer. And I’m also thinking that’s the case because the medical field, government, society, etc. give it so much attention and research. Hmmm, but when it comes to addiction and the emotional/mental disorders – oh well. Great info as usual, Lisa. Necessary info, in fact. Thanks so much for your passion and dedication…
    Bill
    Bill White, Licensed Counselor recently posted…Anger! “Yikes!” How to Understand & Defuse It (You got this.)My Profile

    • I definitely agree the addict has first responsibility, although it’s so much more difficult to embrace all that needs to be done when you don’t understand the disease you have – especially for a teen or young adult. It’s interesting your funding point – the whole effort to study and understand the brain started in 1990 when President Bush challenged the country to do just that – and that’s when we started seeing funding opportunities like never before. The 1990s were labeled the Decade of the Brain and the 2000s, the Decade of Discovery. Let’s hope now is the time to really take addiction and mental illness on, the same way we’ve taken on other diseases, like cancer, HIV, heart disease… As always, I really appreciate your insights and comment, Bill!!

  5. I know this is super important, Lisa, because my pulse quickens and my anger management software boots up as I try to understand why your comprehensive, evidence based, clear explanation above is not mainstream. It is as if there’s a vested interest in this society in remaining ignorant of the science even at the expense of these desperately sad outcomes. What could that interest possibly be?

    Here’s to, as you say Lisa, pulling into 21st Century awareness and out of the dark ages regarding this life and death matter. Thanks for your HUGE part in this endeavor.
    Herby Bell recently posted…Philip Seymour Hoffman – His Death, Our Awakening?My Profile

    • Thank you so much, Herby, for your enthusiasm and support of this effort – one you’ve been long working in, as well. And thank you for sharing this piece with your readers and helping to further spread the word!

  6. What a wonderful, educational piece. Why didn’t I find you 10 years ago when I was in the depths of the cycle of addiction with my ex husband and desperate for information, understanding and direction? I have found your site as a result of you posting one of my blog entries (which I appreciate) I will spend a lot of time here as my ex still has not found recovery after two rehabs and many other attempts at sobriety. Thanks for your research and smarts!! The blog piece you read was part of a book idea I am working on. When I was living in the chaos of the disease I was desperate for books and resources that 1. validated what I was experiencing and 2. gave me real, scientific information about addiction, and real help in how to navigate holding a family together amidst the disease. Wish I had discovered your book “IF You Loved Me You would Stop” earlier than today! It took me years to realize even though it felt like that, that was not a reality. If I can somehow articulate my experience in such a way that it helps a family survive the experience, I want to do that! Thanks again for sharing my piece and for your work on addiction.
    Suzi Pease