Life After Rehab
Recovery from substance abuse is an ongoing process that takes a lot of hard work and dedication. And sometimes – people can slip along the way.
The temptation to use drugs or alcohol can feel like too much to handle for many people.
If you are one of these individuals, you might turn back to your old ways of abusing substances at some point after your initial recovery.
But this temporary setback does not mean that recovery is not possible or that you have failed.
Relapse is a relatively common setback for those seeking lifelong recovery. So it is important to understand the reasons why you may turn to using the substance again at some point. By gaining a greater understanding into your own reasons for drug use, you can better help yourself:
- Plan for post-rehab life.
- Resist future use temptations.
Why Preventing Drug Relapse Is Important
Relapse during substance abuse recovery is not uncommon. As much as 60% of people working through substance abuse recovery return to substance use at least once.1
In some cases, substance abuse relapse rates climb as high as patient relapse rates for various medical conditions, including1:
- High blood pressure.
- Type 1 diabetes.
Beyond the immediate harms of the substances being used again – be it alcohol or drugs, or both – there are some additional, less-obvious risks faced by those individuals who relapse.
Relapse can be very risky for many reasons – not the least of which is skewed dose estimations.
If you find yourself relapsing, you may try and return to your pre-recovery dose – a dose that your body no longer has the same tolerance for. This pre-recovery dose can potentially lead to overdose and other serious health problems.
One drug that makes individuals particularly prone to relapse overdose is heroin, especially when it is taken in combination with other drugs.2,3 Heroin relapse and overdose can even lead to accidental death, as was the case for Janis Joplin – a famous blues-inspired American vocalist who rose to fame in the late 1960s.4
Beyond the risk of overdose, relapse brings with it a whole host of additional health issues related to substance use – including psychological struggles.
If you have ever relapsed, yourself, you may feel as though you have failed. The danger of these feelings of failure is that they may potentially drive you even further into substance abuse, especially if you do not feel that you have a strong support base to work from.
What Causes Drug Relapse?
Everyone has their own reasons for seeking treatment, just as everyone has their own reasons for using a substance again after a period of abstinence. No two people are going to have the same recovery journey, and drug use habits can be difficult to break right away.
Leaving the safe space of a treatment program can also result in any number of feelings that may tempt a person into use again.
Some common reasons that people relapse after treatment include5:
- Stress and anxiety.
- Believing they are no longer addicted.
- Relationship problems, including break-ups.
There also seems to be a distinct gender difference when it comes to particular reasons that may factor into a relapse.5
Men have reported the following as major contributors to relapse:
- Feelings of anger.
- Having excess money.
- Prematurely stopping their aftercare treatment.
Women have reported a different set of contributors to relapse:
- The discomfort of withdrawal.
In addition to these commonly gender-specific drives to relapse, many people also face the challenge of simply wanting to use again due to cravings that may have developed over the course of previous substance abuse.
Abusing a substance can change your brain as it begins to adjust to the presence of drugs in your system. The reason you develop tolerance to a drug’s effects is because your brain has adjusted to higher than normal levels of certain chemicals. When substance use is suddenly stopped, your body may still crave the high chemical levels and stimulation that the substance provided.
The good news is that cravings will begin to ease as you maintain abstinence longer and longer. Detox programs and medications can also play a role in minimizing the cravings you may experience.
While these cravings may never disappear entirely, they will get easier and easier to cope with and resist over time and with proper professional and social support.
Lack of Social Support
Social support plays a major role in recovery, and fostering a sense of belonging within a community that encourages a person’s recovery can help prevent relapse.
Some common factors that have traditionally contributed to the occurrence of substance relapse have included5:
- Relationship problems.
- Prematurely dropping out of aftercare meetings.
All of these factors relate to how well supported an individual feels in his or her recovery journey.
Social Support Helps Prevent Relapse
Social support has been associated with significantly lower risk of relapse among former substance users.6-8 This preventative effect seems to be particularly successful when social support remains strong – or gets even stronger – following the completion of formal treatment.9
Social support has even appeared to have a positive impact for people struggling with a dual diagnosis and typically involves10:
- Encouragement from others towards abstinence.
- Enhancement of personal self-worth.
- Assurance that the recovering user has a sense of belonging within the family or within another social sphere.
Poor Lifestyle Choices
Certain actions you may choose to take after you’ve finished your initial rehabilitation can also increase your chance of relapsing.
Returning to Familiar Stomping Grounds and Triggers
When individuals leave the sober safe haven of formal treatment, they may sometimes go right back to the environment where they abused in the first place.
Returning to the site where the problems began, however, often sets off familiar triggers that that can strongly tempt the individual to abuse the substance again. Hanging around people that are using the substance can also pose irresistible temptations to use again. As a result, the risk of relapse can potentially increase.
So being intentional about avoiding these environmental and social triggers can greatly help you guard against relapse.
Not Dealing with Life Stressors and Other Mental Health Issues
Some people additionally leave treatment without adequately addressing the life stressors and other mental health issues that may have driven them to abuse drugs in the first place.
Therapy – and in some cases, medication – can provide you with the tools that can help you cope with these mental health issues. Most addiction rehab programs will incorporate therapy into your treatment plans and consider therapy to be one of the cornerstones to recovery.
Ultimately, it will be up to you whether or not you choose to implement the tools your therapy has provided when your initial rehab treatment is done. Placing yourself in situations that could lead to the same problems of abuse is a personal choice that may lead to relapse and self-doubt.
Support After Drug Rehab
Having a sense of support is important throughout day-to-day life, but it is especially vital during times of challenge and stress.
Recovering from substance abuse is challenging, to say the least – and feeling encouragement throughout the process can make a huge difference for a person’s long-lasting abstinence. This kind of important support can be provided not only by family and social support groups, but also by your treatment program itself, in the form of aftercare.
Halfway houses – also known as therapeutic communities or sober living homes – are substance-free living environments that focus on recovery and successful re-integration into society. The housing community is composed entirely of recovering substance users so that everyone can support each other in their commitment to a sober lifestyle.
These communities not only help provide a sense of community, but they also reduce substance use temptations that may arise outside of treatment. Therapeutic communities have been found to be very helpful in maintaining abstinence after treatment – as well as in improving employment, legal outcomes, and psychological health.11
Outpatient treatment involves ongoing therapy and counseling just like inpatient treatment. The main difference between the two treatment structures is in the intensity of the treatment, as those in outpatient treatment get to return home at night after treatment. Sometimes medication support may be necessary to reduce cravings and to keep the recovering individual safe.
Certain individuals may pursue outpatient treatment as their primary recovery plan – while others may choose to stay connected with outpatient treatment following a stay at an inpatient facility.
Extending treatment beyond the inpatient treatment period can help further build up coping mechanisms and keep the individual’s drug refusal skills strong amidst temptations.
Certain substances may necessitate medication therapy to help a user through recovery. Opiate or heroin users, for example, may be prescribed buprenorphine or naloxone to help reduce cravings.
Sometimes, medication assistance will only be needed for a short while following formal treatment. Other individuals will need a longer-term medication plan to help them resist relapse. The duration of medication use will depend on the substance of abuse as well as the individual’s particular needs.
Medications can help with recovery in a number of ways. They can:
- Help to reduce cravings by mimicking the drug’s effect.
- Preventing the effects of the substance that is abused.
- Treat symptoms or conditions (such as depression or anxiety) that may develop as a result of stopping drug use.
- Take the edge off of temptations to use.
- Give a recovering person a more stable emotional and physiological base for maintaining abstinence.
Support groups are organizations of former substance users that come together to provide sobriety support for one another. The most well-known model of these is the 12-step program (one example of this is Alcoholic Anonymous), which follows a predetermined set of steps toward recovery, focusing heavily on surrender to a higher power and making amends with loved ones.
There are also non-12-step programs that take a more secular approach to recovery support. These non-12-step programs include:
No matter what kind of support group you choose, engagement with these important sources of aftercare has been associated with significantly lower rates of drug use for up to 30 months following formal treatment.12
Getting Support from Family and Friends
Beyond professional support, the love and encouragement from friends and family can have a major impact on a person’s recovery journey. Recovering users stand the best chance for lasting success when they are equipped with both professional aftercare and social support.
Advice to Family and Friends of a Loved One Seeking Recovery
Helping a friend or family member during the challenging post-treatment adjustment can come in many different forms. Below are some useful tips for supporting a loved one in their newfound sobriety.
1. Offer a Sober Environment
It is vital to reduce potential temptations that might make your loved one relapse. Offering a substance-free (and paraphernalia-free) environment – even if it’s just for visiting – is an excellent way to demonstrate support during recovery. A supportive environment also includes finding activities to engage in that don’t include substance abuse triggers.
Recovery isn’t an easy process, and making it as temptation-free as possible can really help during this challenging time.
2. Avoid Judgment, Offer Compassion
Throwing blame around does nothing to help a person through recovery. Judgment can come in different forms – from berating a person for ever having used to asserting that recovery is as easy as “just not using.”
Judging recovering users only serves to alienate and isolate them, which runs directly counter to their chance for sobriety success. Instead of coming at the person with judgment, consider taking on a compassionate approach to the situation.
Addiction can be a major struggle to overcome, and a person who has completed a treatment program is demonstrating the desire to heal. Even through potential relapse scenarios, extending a compassionate, understanding hand will help a person much more than putting him or her down for struggling in the face of a challenge.
3. Seek Treatment for Yourself
The effects felt by substance abuse often ripple out and touch people close to the user. Dependency and addiction can be a burden – not only on the person who was abusing the drug, but also on friends and family members who feel helpless in the face of a loved one’s decline.
These effects may extend into post-treatment as well, as many people who are close with a recovering user unknowingly take on the burden of recovery.
Seeking family therapy and personal counseling for yourself can be an invaluable source of strength if your loved one has been struggling through addiction and recovery.
It helps to have the freedom to safely express all the emotions that can come up throughout the recovery process – without dropping them on the person trying to maintain abstinence, as this person already has a lot to cope with.
Learn More and Get Recovery Support
Recovery from substance abuse is a journey for everyone involved, from the user to the people close to them. Post-treatment life can be challenging, and getting proper support during the process can make a big difference in a person’s abstinence journey.
- Treatment and recovery. (2014). National Institute on Drug Abuse.
- Davoli, M., Bargagli, A. M., Perucci, C. A., Schifano, P., Belleudi, V., Hickman, M., et. al. (2007). Risk of fatal overdose during and after specialist drug treatment: the VEdeTTE study, a national multi-site prospective cohort study. Addiction, 102(12), 1954-59.
- Smyth, B. P., Barry, J., Keenan, E., Ducray, K. (2010). Lapse and relapse following inpatient treatment of opiate dependence. Irish Medical Journal, 103(6), 176-79.
- Janis Joplin biography. Biography.com
- Levy, M. S. (2008). Listening to our clients: the prevention of relapse. Journal of Psychoactive Drugs, 40(2), 167-172.
- Havassy, B. E., Hall, S. M., Wasserman, D. A. (1991). Social support and relapse: commonalities among alcoholics, opiate users, and cigarette smokers. Addictive Behaviors, 16(5), 235-246.
- Ellis, B., Bernichon, T., Yu, P., Roberts, T., Herrell, J. M. (2004). Effect of social support on substance abuse relapse in a residential treatment setting for women. Evaluation and Program Planning, 27(2), 213-221.
- Wasserman, D. A., Stewart, A. L., Delucchi, K. L. (2001). Social support and abstinence from opiates and cocaine during opioid maintenance treatment. Drug and Alcohol Dependence, 65(1), 65-75.
- McMahon, R. C. (2001). Personality, stress, and social support in cocaine relapse prediction. Journal of Substance Abuse Treatment, 21(2), 77-87.
- Warren, J. I., Stein, J. A., Grella, C. E. (2007). Role of social support and self-efficacy in treatment outcomes among clients with co-occurring disorders. Drug and Alcohol Dependence, 89(2-3), 267-74.
- Vanderplasschen, W., Colpaert, K., Autrique, M., Rapp, R. C., Pearce, S., Broekaert, E., et al. (2013). Therapeutic communities for addictions: a review of their effectiveness from a recovery-oriented perspective. The Scientific World Journal, 2013: 1-22.
- Kissin, W., McLeod, C., McKay, J. (2003). The longitudinal relationship between self-help group attendance and course of recovery. Evaluation and Program Planning, 26(3), 311-23.