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…
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.
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:
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:
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.
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.
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.
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:
©2014 Lisa Frederiksen
*8.24.16 Don Flattery commented on a FB posting of this article, and I believe he makes an excellent point, and have added his comment here: “While I understand the author’s broader point, I slightly disagree with the statement that, ‘addiction starts with substance abuse’. Addiction often starts w/substance abuse but it also can start from medically prescribed overuse of opioids for all manner of pain (and often for purposes for which they were never intended). Medically prescribed overuse is a clinically proven pathway to addiction. The fastest growing age group of those suffering prescription opioid overdose deaths is 45 to 54 yrs old. These fatalities are likely among a group who may have become dependent, then addicted to their prescribed medications. They are not (mostly) young people ‘abusing’ opioids before a high school social event. The reason making it clear that abuse and medically prescribed overuse of opioids are both pathways to addiction is important is that strategies to address both may be very different and should not be ignored.”