Question:
Is relapse common among alcoholics and other drug addicts?
Answer:
Yes, unfortunately. We have a society that promotes the heavy use of alcohol and turns its back when someone relapses. That's because they treat addiction as moral weakness, not as a chronic medical problem. A recovering patient of mine left his appointment yesterday and before he got home, he counted 70 places beckoning him to drink in a 10-block radius, including liquor stores, bars and grocery stores with their beer ads. Then when he got home and turned on the television, he saw beer commercials and story lines filled with references to alcohol. Environmental cues like these often trigger relapse.
When you're an alcoholic or other drug addict, your biochemistry goes haywire too. Especially your liver, which metabolizes whatever drug you're addicted to. Hypoglycemia is common among active alcoholics, but instead of burning sugar they're burning alcohol.

People in recovery need to understand that their body's craving for sugar often gets mixed up with their craving for alcohol. They need to find a substitute for alcohol to help them deal with the biological cravings caused by their fluctuating blood sugar. That's why there's always lots of candy around in AA [Alcoholics Anonymous] meetings. I advise my patients to use a hypoglycemic diet with six meals a day to avoid wide swings of their blood sugar.

In addition to a good healthy diet, I emphasize B complex vitamins. Thiamine, is good because it helps prevent tremors and delirium in alcoholics. L glutamine, an amino acid [available in health food stores]. This is a natural method to help prevent the cravings that people may feel.

Exercise also is very important in preventing relapse. It can produce a natural high from the endorphins.

Question:
Is relapse more common with some drugs than others?
Answer:
Relapse among alcoholics may be more common simply because there are more alcoholics and because alcohol is so readily available as a social lubricant. The recovering alcoholic in particular faces enormous social pressure to drink. Think about it. When you go to a party, more often than not, you'll be offered a drink before anything else. When you're socializing with friends or co-workers, bars are common places to meet. But even if you go to a restaurant, the first question out of the waiter's mouth is "What would you like to drink?". Most people don't recognize how difficult we make it for recovering alcoholics to stay sober. If you know someone in recovery, try to be sensitive to what is, for them, a constant struggle. That's why I have plenty of soft drinks available whenever I entertain.

Some addicts say that the craving for cocaine is more powerful than that for other drugs. Tell that to an alcoholic in the early stages of recovery! A craving is a craving. What's important to keep in mind is that all addictive drugs have an effect on brain chemistry and liver function. Brain chemistry presents the biggest challenge to recovery because we don't fully understand the kinds of neurological changes long-term drug use causes. The liver, after all, can regenerate if the patient stops using and eats well.

Of course alcoholics need to remember that just because their liver function has returned to normal, it doesn't mean they can drink again. I find it's easier to use an analogy to explain this to my recovering patients than to go into the complicated medical reasons. I tell them that before they started drinking their liver was like a cucumber. Then alcohol turned it into a pickle. And we all know that pickles can't become cucumbers again.

Question:
What causes relapse?
Answer:
Addiction is what we call a "biopsychosocial" disease, which means that biology, psychology and a person's social environment all contribute to its development. Each one of these factors plays a role in relapse, which makes recovery more difficult for addicts than for patients suffering from other treatable medical conditions. The battle has only just begun once a patient completes detoxification. He or she may need to begin seeing an alcoholism or addictions counselor, a therapist or a psychiatrist who can help them deal with the psychosocial problems that may have contributed to their drinking or drug use. Depression is especially common among alcoholics, particularly women. Regular attendance at self-help groups like AA is important. AA will help alcoholics understand the scope of their disease and prevent them from becoming bitter and angry, or what are known as "dry drunks."

For recovery to be successful, people need to make major changes in their lives. I urge my patients to develop a plan of action to avoid relapse. It's a good idea for them to make a list of dangerous situations and how to deal with them. If they're invited to a wedding, let's say, they may want to plan to leave early. Or they may want to make sure in advance that a non-alcoholic beverage will be available at their table if they're going to be called upon to make a toast.

Patients need to examine their drinking or drugging lives carefully to decide what situations may have stimulated them to use. Maybe they'll find that every time they went to visit their mother they got into an argument and started to drink. If that's the case, it's probably not such a good idea for them to visit their mother in early sobriety or until they've worked with a therapist through the issues that cause these arguments.
Like they say in AA, stay away from or avoid the people, places and things that are going to remind you of drinking.

Question:
Are some alcoholics and other drug addicts at higher risk for relapse?
Answer:
Addicts without a strong support system are at the highest risk. Let's face it, if you're homeless, jobless or without a loving family, the deck is definitely stacked against you. Therefore, it's best to get patients into treatment before they lose everything.
The first year of sobriety is particularly tough because people have to give their bodies time to get healthy after dependence on a drug that has caused real physiological changes, including cognitive impairment. It takes the body a long time to rid itself of a drug's aftereffects on the brain and the nervous system.

Recovery is hard work; at a minimum it requires proper nutrition, exercise, medical follow-up, counseling and regular attendance at an appropriate self-help program.

Question:
Are there any danger signs associated with relapse?
Answer:
When an alcoholic or addict says he or she doesn't need to go to any more self-help meetings you can be sure that there's trouble ahead. It may mean "I don't want to go to AA because I don't consider myself an alcoholic. And I believe that I can drink again moderately." The same goes for abandoning their diet or exercise routine or deciding to stop taking prescribed medications such as Antabuse on their own.

Boredom and loneliness are other big concerns. Using takes up a lot of an addict's time. In the initial stages of recovery, they need to fill this lost time with frequent attendance at self-help groups that are filled with people who are going through exactly what they're going through.

Question:
Is there anything a recovering person can do if they feel that relapse is imminent?
Answer:
Obviously, staying away from negative influences and finding support is critical. Addicts have to replace their drug habits, with new, healthy habits. Participation in a self help group and a good relationship with a sponsor are the best defenses for a recovering person to confront the self-pity, complacency and dishonesty that often precede relapse.
AA has a very simple acronym, HALT. It means avoid getting hungry, angry, lonely or tired. Each of these areas is critical in recovery. When alcoholics get the urge to drink, they should eat something. Exercise. Get proper rest. Go to a meeting or call their sponsor. That way they can talk to someone else, particularly if they're upset or angry.

People need to be patient about alcoholism and other drug addiction. It takes time to recover. These illnesses are not something you get over in a couple of days.

Question:
What can the family and friends of an addicted person do to help prevent relapse?
Answer:
Understanding that addiction is a disease is key. Try your hardest not to be moralistic or punitive in dealing with an addict. Instead of making threats or getting angry, express your concern. Say "I'm afraid you're getting sick again" and urge them to go to a meeting and help them talk through their problems. But don't allow yourself to be manipulated either; offer to go to an open meeting of a self-help group with them.

My patients are full of guilt, shame and resentment about their alcoholism or addiction. These are all stigma-related and they interfere with the ability to recover. But we're dealing with a medical problem that's like other chronic diseases. Addicts are people, too, with a right to get well. They need the opportunity to redeem themselves. If you shut them out of your life, they don't have that opportunity.

Question:
Many alcoholics and other drug addicts in recovery relapse more than once. Does this mean they aren't as serious about their recovery as other addicts who have maintained their sobriety continuously since first achieving abstinence?
Answer:
Every case is different. Some people don't have the necessary support systems or they're facing another major crisis in their lives
.
As much progress as we've made in educating the public about alcoholism and other drug addictions, most people still don't understand the chronic nature of these conditions. Because of the stigma that still surrounds drinking too much or using other drugs, the public often blames the addict when he or she relapses. This just isn't the case for patients who suffer from other behavior-related diseases. In fact, a University of Pennsylvania study has shown that addicted patients comply with treatment advice just as often as patients with asthma, hypertension or diabetes do.

We have a responsibility as a society, too. When a public figure in recovery has a slip the public should not become moralistic or punitive. They should realize that the more well-known the person is, the greater the stigma and the harder their fall. We need to be more forgiving and recognize that the people who suffer from the disease of addiction must be treated with compassion, not contempt.