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Will Drug Rehab Work the Second Time?

Travel to rehab

Starting a drug rehab program for your drug or alcohol addiction takes a lot of strength, courage, and determination. If you have relapsed, you may be wondering several things:

  • If you made the right decision to enter treatment
  • If this means you have gone all the way back to square one in your recovery
  • If it is worth it to try again

You may also be struggling with feelings of shame and regret, or thoughts that you have failed. It is important for you to know, however, that relapse is very common and does not signal the end of your recovery journey. Returning to rehab for a second time might be just what you need to increase your chances of long-term success.

The National Institute on Drug Abuse (NIDA) actually even defines addiction as a chronic, relapsing disorder,” highlighting just how common relapse is. Rates of relapse have been reported as high as 60%, and it is commonly viewed as a normal step on the path to long-term recovery.1,2 However, this doesn’t mean you should not treat relapse seriously. Relapse can lead you back into active addiction and all of the devastating consequences that come with it, so you’ll need to approach it with the same or greater commitment to recovery you had the first time you entered treatment.

Treatment for substance abuse does improve outcomes, and relapsing is not evidence that treatment was not effective. Oftentimes, it is an indication that you need to brush up on things you originally learned in treatment that you may have forgotten, or that some changes need to be made to your treatment plan, which could include additional help that you didn’t receive the first time. NIDA states that relapse indicates that “the person needs to speak with their doctor to resume treatment, modify it, or try another treatment.”2

Handling a relapse is not something you need to deal with on your own. Returning to treatment can help you refocus your recovery efforts as you move past your relapse episode.

Why Does Relapse Happen?

There are varying descriptions of what actually constitutes a relapse, such as the number of times you engaged in substance use, or the amount you used. However, there is a commonly accepted differentiation between experiencing a lapse and a relapse:

  • Lapse: A lapse can be thought of as an isolated incident, a mistake, or a slip-up.3  In other words, during a lapse you may have impulsively engaged in a night of alcohol or drug use after a period of sobriety but have since stopped and recommitted to recovery.
  • Relapse: During a relapse, your substance use may last for days and you may notice a return to other addictive behaviors such as lying about your use.

If you have experienced a lapse, you may be able to get back on track on your own or with relatively little additional support, but if you have experienced a relapse, you may very well need to return to rehab.

Relapse is a complex phenomenon—often preceded by various contributing elements and ultimately happening for any number of reasons. Of significant importance, though, is the fact that addiction is a disorder that can negatively impact areas of the brain that influence processes such as self-control and reward.1

When you start to use a substance and it feels good, neurochemical changes are made that reinforce an association between the euphoric feelings and certain drug-related environmental cues related (such as the people you use with and the places you use). In fact, as time goes on and these associations are strengthened, dopamine release will increase in response to these environmental drug cues and may be accompanied by strong cue-dependent cravings. You may also begin to experience a less robust normal release of dopamine in response to natural rewards like eating, exercise, or sex. With the resulting lowered ability to experience pleasure from natural rewards and the brain’s heightened response to drug-related environmental cues, it’s not difficult to see how relapse can occur. Further complicating this process is the phenomenon of long-term substance use negatively impacting areas of the brain responsible for executive functions like decision-making and impulse control, which can make it harder for you to resist temptations and make choices in line with your recovery.4

Relapse Risk Factors

Environmental cues may result in very strong cravings, so returning to the same environment when you leave treatment, and thus returning to the same people, places, and things that trigger your substance use, can increase your risk of relapse.

Other factors that have been shown to increase your likelihood of relapse include:2,5

  • Having one or more co-occurring mental health disorders, especially if they were not adequately addressed during treatment.
  • Being of a younger age.
  • Feeling a lack of self-efficacy and having poor coping skills.

There is also some evidence that factors associated with relapse may differ between adolescents and adults. One study found that adults were more impacted in social situations during which they were tempted or when trying to cope with a negative emotion and experienced an urge to use. Adolescents were more likely to relapse while trying to enhance positive emotions during social situations, when dealing with social pressures, or when experiencing negative emotions related to interpersonal conflict.6

Warning Signs

Aside from being aware of individual factors that might increase your risk for relapse, some potential warning signs or changes in thoughts/behaviors to look out for include:

  • Skipping 12-step or other support meetings.
  • Letting your recovery take a back seat/no longer making it a top priority.
  • Not feeling adequately prepared to handle the transition back to normal life after finishing treatment.
  • Constantly thinking about using.
  • Experiencing overwhelmingly negative mood states with which you feel unable to cope.

Treatment, Not “Cure”

While addiction can be treated successfully, like many other chronic illnesses, there is no “cure.”2

Primarily, treatment entails helping you learn how to manage your addiction more effectively so you can maintain your recovery. This means that starting a rehab program is and won’t be all you need to do to maintain recovery. You can look at is a foundation you need to build on.  Long-term success requires you to stay vigilant and have a solid plan for how to stay on track.

Since there is no “cure” for addiction and because those in recovery sometimes encounter setbacks, you may find yourself entering rehab a second, third, or fourth time. Try not to assume that because you’ve relapsed that treatment doesn’t work or that you’ve reached the end of the road. Instead, recognize it as a sign that some more work needs to be done and embrace it as an opportunity for continued self-improvement.

How you think about your relapse is important and can strongly influence the next steps you take. You have a choice to see it as an opportunity to obtain further education and support along the way to long-term recovery rather than as a shameful experience or failure.

We all need a touch-up on the things we are working on sometimes, and a relapse is best viewed as an indication that you need to make some adjustments to what you are doing to maintain recovery.

Adjusting Your Plan

Doctore and patient

If you have relapsed and decided going back to rehab is your best course of action, it is important to be aware that your treatment plan may need to be adjusted this time around. Your treatment team can discuss with you what worked the first time and what should change the second time. If you don’t feel you can advocate for yourself, seek the help of others so you make sure you get what you need this time.

Perhaps you need a program that offers a different approach to treatment and relapse prevention. For example, some studies have shown how mindfulness-based interventions can promote self-control, increase an individual’s capacity to experience natural rewards, decrease emotional reactivity, and aid in relapse prevention.4 Different programs offer different resources, so make sure you do some research and find a rehab that might offer something you may have missed the first time.

Another study found that individuals who completed treatment at facilities that offered shorter programs had higher rates of relapse,5 so perhaps you need a longer stay this time around.

Additionally, if you didn’t engage in aftercare upon being discharged from your first program, this might be a priority for you, as oftentimes relapses are associated with not having a proper plan and support to maintain recovery. This includes:

  • Making sure you have learned adequate coping skills as studies have associated relapse with not learning how to handle negative moods states, especially stress.6,7,8
  • Getting assistance with building a life after recovery, including education and/or employment. One study showed between a higher likelihood of relapse and a lack of employment.9
  • Setting yourself up for success by continuing other forms of help and treatment such as seeing a therapist and/or attending regular meetings.
  • Participating in family therapy to address issues and conflicts with loved ones that may be triggering.

In summary, if you have relapsed after treatment it does not mean you will never find lasting recovery or that it is worthless to try again. Many people relapse, go to rehab a second time, and go on to find lasting recovery.

References:

  1. National Institute on Drug Abuse. (2018). The Science of Drug Use and Addiction: The Basics.
  2. National Institute on Drug Abuse. (2018). Drugs, Brains, and Behavior: The Science of Addiction.
  3. UC Santa Cruz Counseling & Psychological Services. (n.d.). Relapse Prevention.
  4. Priddy, S. E., Howard, M. O., Hanley, A. W., Riquino, M. R., Friberg-Felsted, K., & Garland, E. L. (2018). Mindfulness meditation in the treatment of substance use disorders and preventing future relapse: neurocognitive mechanisms and clinical implications. Substance abuse and rehabilitation, 9, 103-114.
  5. Andersson, H. W., Wenaas, M., & Nordfjærn, T. (2019). Relapse after inpatient substance use treatment: A prospective cohort study among users of illicit substances. Addictive Behaviors, 90, 222-228.
  6. Ramo, D. E., & Brown, S. A. (2008). Classes of substance abuse relapse situations: a comparison of adolescents and adults. Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors, 22(3), 372-9.
  7. Sinha, R. (2011). New findings on biological factors predicting addiction relapse vulnerability. Current Psychiatry Reports, 13(5), 398–405.
  8. Witkiewitz, K., & Masyn, K. E. (2008). Drinking trajectories following an initial lapse. Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors, 22(2), 157-67.
  9. Moos, R. H., & Moos, B. S. (2006). Rates and predictors of relapse after natural and treated remission from alcohol use disorders. Addiction (Abingdon, England), 101(2), 212-22.

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