Relapse

If a relapse occurs, the counselor and patient should use the session immediately following the relapse to identify and process the events, thoughts, and feelings that precipitated the relapse. This step is called relapse analysis.

Relapse to drug use is a common occurrence that can be emotionally devastating to the patient. The counselor must communicate to the patient that a relapse to drug use does not mean that the entire treatment program has been a failure. Drug ddiction recovery is definitely not all or nothing. There is a residual savings. When patients relapse, the counselor will want to convey to them that they have lost their "clean time" but not the knowledge and experience gained during their treatment process. The counselor should educate the patient about relapse and about the importance of taking corrective and positive action rather than being overwhelmed by feelings of depression or failure. Most episodes of drug use can be managed without seriously interrupting the treatment process. They can be used in a positive and enlightening way to strengthen the recovery process. In dealing with a relapse, the counselor should use the general principle that relapse is caused by failure to follow one's recovery program. Thus, the counselor should identify where the patient deviated from his or her recovery plan and encourage the patient to recommit to the recovery program.

Levels of Severity of Relapse

Relapse can be viewed as having three levels of severity, which determine the appropriate therapeutic response. The counselor must understand the three types of relapse and the appropriate response to be utilized in each case. The counselor should communicate to the patient that any level of resumed drug use is a relapse, necessitating analysis of the process and recommitment to one's recovery program. In other words, a "slip" still is a relapse. The levels of severity are to assist the counselor in determining the appropriate action to be taken.

Slips

The least severe type of relapse is a "slip," a common occurrence that involves a very brief resumption of drug use associated with no signs or symptoms of drug dependence. Such an episode can serve to strengthen the patient's recovery if used to identify areas of weakness and point out solutions and alternative behaviors that can help prevent future drug use from occurring.

Several Days of Drug Use

The next most severe type of relapse is when the patient resumes drug use for several days, and the use is associated with some of the signs and symptoms of drug addiction. In such a case, the counselor probably would want to intensify treatment temporarily, which can be effective. We have found that intensified contact will usually reinstitute abstinence. The patient should be encouraged to review what happened and learn from the experience how to avoid a relapse in the future. The patient also should be encouraged to recommit to his or her recovery program.

Sustained Drug Use With Resumption of Addiction

The most serious form of relapse is a sustained period of drug use during which the patient fully relapses to drug addiction. Often a patient who relapses to this extreme also will drop out of treatment, at least temporarily. In this case, if the patient returns to treatment, he or she may need to begin treatment with a drug detoxification, in either an inpatient or outpatient treatment center. The decision to detoxify a patient as an inpatient or an outpatient should be made conjointly by the treatment staff involved. Their decision should be based on the severity of the relapse, the particular drugs used, the availability of social support, and the possibility of an unstable medical condition.