Power to the Parents: The Problem of Relapse

Power to the Parents is a feature that appears in every issue of The Guide to Good Health to help parents and guardians who are concerned about the widespread problem of young people and substance abuse. If you know your child is using drugs or alcohol or if you are trying to prevent your child from using, you will find practical advice and support here from expert professionals at Gateway Rehabilitation Center. In this issue, the problem of relapse is discussed by Richard Foster, Ph.D., executive vice-president for clinical programs at Gateway Rehab, and Nicole Kurash, Director of Gateway's Youth Program.

How do you define relapse?
Dr. Foster: Relapse is a process, not a single event, and the end point of that process occurs when you pick up a drink or a drug. It's a process of negative behaviors and attitudes that lead one back to substance abuse. We define recovery as abstinence + change, so if you have not made changes, at some point you are likely to fall back into old behaviors. We consider relapse to be both mental and physical, and the mental part – where you're thinking about using again – can last for days, weeks or months. Most people think about it for a while before using again.

Relapse seems to be fairly common. Is it inevitable?
Ms. Kurash: Many people relapse, but no, relapse is not inevitable. There's a myth out there that says that you have to relapse as part of your recovery, but that's not true. It's important to work on whatever brought you to use drugs or alcohol in the first place. What were you trying to numb? If you don't work on that, it will remain a source of emotional pain. Childhood trauma, especially any form of abuse, is a huge issue that can't be adequately dealt with in a 28-day program. You have to continue to get help. The triggers that lead a person in recovery to relapse are individualized - different for everyone. Self-help groups are important because of the mental aspect of relapse. You can talk yourself into using again, but if you're in a group, there will be 20 or so people in that group who can talk you out of it.

Does relapse mean failure?
Ms. Kurash: Relapse is not failure. Hopefully, it's an opportunity, to fix whatever didn't get fixed the first time around. If you don't change the situation or thoughts that led to the relapse, it will keep happening. When you come back into rehab, we'll retrace the process with you so that you can identify where things went wrong. For parents, a relapse may feel like failure. But if your child came and told you, that's a positive thing. Parents may say, "Oh no, we went through rehab and now we have to start over, from scratch." But in fact, it's never starting from scratch; you build on what you learned before.

How can parents help prevent their child from relapsing?
Dr. Foster: Parents can help prevent relapse by supporting the treatment recommendations for the child, following the home contract that was worked out at Gateway, and encouraging healthy activities, such as getting a job, going to meetings and making new friends. It's critical to have a new, healthier network of friends. Otherwise, the young person will feel isolated and miserable and that jeopardizes recovery. For young people especially, a new group of peers is one of the most important factors. Parents should try to assure that the child does not miss meetings. Provide rides and do whatever it takes to get them there. If the child is living at home, then obviously parents have more control.

Are there "red flags" to warn parents that the child is relapsing? How can they recognize relapse?
Ms. Kurash: Red flags are the old behaviors and attitudes re-surfacing – the manipulation and lying, changes in appearance, seeing friends that the child used within the past, or money suddenly missing from the house. When the parent is seeing these signs, they should confront it directly and quickly and state their observations. Part of Gateway's home contract is a plan for this that the child signs. It says, "If I relapse ..." so they know exactly what to expect. The danger of a relapse is in hiding it. If the child is back at it in full, but denies it, parents have to do what they did in the beginning. Have consequences – take away privileges like cell phones and cars. The child has to earn back your trust.

What is the danger of relapse?
Dr. Foster: After you've been clean, using again can be a lot worse; the fall is steeper. There is greater risk now; people are mixing drugs more and the combinations can be deadly. After you've been abstinent, your tolerance is lower and overdose is a greater risk. Parents can ask their physician for a prescription for Naloxone (Narcan) to keep at home in case of overdose. Narcan reverses opioid overdose. It can be injected into a leg or arm muscle, or sprayed into the nose. It wakes the person up and keeps them breathing; you must also call 911 and get them to an emergency facility.

How do you encourage parents who are struggling with this?
Foster: Parents need to remember that they can be there, guiding and providing boundaries, but they cannot force their child to not use. They can identify roadblocks to recovery and then do their best to remove them. The relapse process can be interrupted before the child uses again. However, if the child is using again, then it's important to get an evaluation and go back into rehab.

It's a lot for parents to deal with. But research shows that the longer the young person is in treatment, the greater the chances of recovery are. The first 90 days after rehab are critical – you need to do something every single day that moves you toward recovery. Go to a meeting three times a week, set goals each morning and keep a daily inventory in which you review your day, looking for warning signs but also noting the things you've done well. These steps will help stop the relapse process.

We encourage parents to attend support group meetings and educate themselves about substance abuse; there is good information online and Gateway's website has great information plus links.

To learn more, visit gatewayrehab.org.