Addiction is a chronic relapsing disease. Thus, chronic relapsers pervade the illness. These are people who are incapable of remaining clean. It's upsetting to see people relapse after treatment. They know so much about how to get well. When it comes to preventing relapse, they fail to do so. Why is that? It goes to show that knowledge of recovery does not entail strong, sound recoveries.
Chronic relapsing in addiction is not a mystery. The link between the head and the heart is the longest. In recovery, it takes a considerable length of time to make the head to heart connection. Some people get it on their first try, while others, have to struggle a great deal more.
Chronic relapsing is predictable and treatable. For it leaves behind a clear pattern of sobriety and addiction. Chronic relapsers share certain characteristics and traits. By identifying these features and treating them, recovery is possible.
Below is a list of traits that a chronic relapser will have. These features are responsible for the relapses. What is at the heart of these traits, is an unwillingness to do what it takes to stay clean.
They have enough knowledge about CBT, 12-steps, and recovery to be able to hold workshops at rehab. When it comes to applying this knowledge to relapse prevention, they fail. Instead, the knowledge becomes a weapon against loved ones. They will use it to manipulate situations so that they can relapse. Or at least, use it to justify it. Whichever the case it is, they will not use such knowledge for lasting sobriety.
They are cynical whether the recovery will work for them. The relapses are jewels to their cause. They can justify each relapse as evidence that recovery is a fantasy at best. Their hopeless stance on getting well allows them to wallow in self-pity and shame. It brings them on a constant cycle of relapses. At the core, they are not interested in doing what it takes to recover. Thus, always seeking excuses to remain in a helpless condition.
They can't help but relapse after treatment. Sobriety may last from hours to days, or weeks after discharge. They may even be using during treatment, and get thrown out as a result. At times, chronic relapsers will leave treatment without clinical approval. They can't sit still with the feelings that come up from not using.
They go in and out of rehabs on a regular basis. They know how to play the treatment game. They know how to work their therapists.
They feign trauma, and trump issues, or play up their dual-diagnosis symptoms. They are masters of manipulation. They can charm their way to exhaust loved ones of their financial and emotional support.
In other words, they are treatment savvy. At times, they will cause havoc in treatment centres, being that unwanted virus in groups. They know how to use treatment to meet their agenda.
They know how to survive in their addiction and their so-called recoveries. They use their charm and intelligence that has helped them to survive harsh times. They will continue to use it in the attempt to get their desires fulfilled. These personality traits developed to help them survive dangerous using. And it will not stop them from escaping what they consider to be "uncertain recovery."
Chronic relapsers have done 12-step work as far as steps 1,2, and 3 go. They have even been able to do it with the aid of a sponsor. A real commitment to work the program has been something unattainable. They have attended countless meetings. They have experienced enough of 12-step recovery to prove that it can't work for them. Again, finding proof for their relapses, self-pity, and shame.
These are character traits that encourage negative behaviours. Examples of Axis II personality disorders are as follows:
(a) Borderline Personality Disorder (BPD)
(b) Antisocial Personality Disorder (ASPD)
(c) Narcissistic Personality Disorder (NPD)
We have written an article on NPD. Do click here, to know more about this illness, and how having it will cause problems in recovery.
Also, you may check out our in-house article on "co-morbidity and addiction." Click here to find out how having a comorbid illness may be a factor for addiction.
In spite of their constant relapses, there is a reasonable solution to the problem of chronic relapsing. Below is a list of treatment strategies and techniques suited for treating them:
A greater length of treatment does not mean extending to 90 days from the initial 28. No, it means spending longer than nine months in rehab. Staying this long may sound incredible and overwhelming.
It takes a chronic relapser at least three to six months to arise out of the mental fog of denial. Furthermore, the experiences of PAWS (Post-acute withdrawal syndrome) will disturb the recovery process. Thus, the chronic relapser will need a longer time to awaken and recover from the addiction.
Any period shorter than the recommended will jeopardise lasting recovery. It's because either PAWS or denial will bring the chronic relapser back to the disease. To know more about PAWS, do take a view at our article on the subject.
Treatment is about facing the feelings and the problems. Thus, anything that distracts clients from this invaluable process needs removing. It could be contact with the outside world such as with family. Or it could be in the form of electronics such as computers and smartphones. It may even be in indulging in coping mechanisms, for example, eating lots of junk food/snacks. We recommend removal of distractions so that the work of recovery can get going.
Chronic relapsers tend to talk the talk, but they don't walk the walk. They know how to talk during therapy and engage well in treatment programs. They can say they know what's wrong when they have no idea the reality of their problems. It's essential for them to realise that recovery takes bold action. That means to face the truth of the problem and grow up. What matters in the end, is the action, not the words.
Addiction is a family illness. With chronic relapsers, we see the sickness more in family dynamics than with any addict. We could treat the user, but if we do not address the family situation, we are risking a relapse. It's because a healthy addict will become sick again once put in his/her home environment. If the family is unwilling to change, we recommend that the addict seeks to live outside the home.
We tell family members to seek help through CODA (Codependents Anonymous) or Al-Anon. At least, in these groups, families can find the closure needed. They will be able to recover from having lived with an addict. Such recoveries and closures are necessary for holistic healing.
In treating chronic relapsers, we have to be harsh to be kind. Chronic relapsers will go back to their families to seek support. Be it on an emotional or financial level, families will enable the addiction.
This behaviour needs to stop because enabling only feeds the addiction. Chronic relapsers must recognise that they can no longer feed off their enablers. Using the family as leverage is powerful in swaying addicts to recovery. In some circumstances, this could include the use of legal and custody leverage.
Chronic relapsers are treatment-savvy, cunning, and manipulative. It's important not to accept their word at face value. Instead, it's necessary to observe their behaviours. As they are not comfortable being honest, it's important to pay close attention to every detail of their lives. Watch for inconsistencies and train them to be honest through accountability training.
It's not enough to sign chronic relapsers up for 12-step programs post treatment. Chronic relapsers will entertain the 12-step program for a while. When life starts to pick up, its necessity will fade in due time.
What's important is to get them hooked on it while in treatment. For chronic relapsers, it means doing the full 12-step program while in treatment. It's advisable to do it either with a counsellor or sponsor. It's imperative that upon discharge, they have strong convictions on recovery.
Chronic relapsers need to live within the limits and boundaries of recovery. There must be a constant emphasis on accountability, responsibility, and consistency. Even beyond treatment, they need to be accountable to loved ones on a regular basis.
At Solace Sabah, we question our clients on their commitment to recovery. When dealing with chronic relapsers, we ask them some questions, which may hit home:
"Do you want this (recovery)?"
" Are you done with it (addiction)?"
The questions may be simple, but they do encourage the addict to think about what they want in life. It will hurt when asked these questions, but the therapeutic value is invaluable.
Sometimes we have to let our clients go against clinical advice. But, before doing so, we warn them about the life they choose to take hereon. We do this because those who are resistant to treatment may profit from a relapse.
It sounds harsh but one has to reach a point where he/she wants the help given. Without the enabling, addicts will be more willing to seek treatment. A willing addict bears more fruit than one who hadn't chosen treatment.
Behavioural interventions have to be immediate with chronic relapsers. Intervening a days' later is ineffective as the intensity of the moment has gone. In such interventions, there cannot be any "wiggle" room for manoeuvring. The addict needs to comply to get well. It has to be instructive, assertive, plain, and simple.
Having structured time is essential to recovery for chronic relapsers. The dead void of empty time is a huge trigger for relapse. Hence, it is important for chronic relapsers to be busy with activities from waking up to bedtime.
Recovery is the chronic relapser’s full-time job. It requires the addict to be punctual, managing time well and prioritising events.
Chronic relapsers will use words to minimise the meaning. For example, "I was kinda lonely." Get them to say what they mean: "I was lonely." Such words like "kinda and sorta", come from a place of half measures. Get them to answer questions with either an affirmative "yes" or a negational "no". It will confront their dishonesty.
Chronic relapsers are an entitled lot. They want people to serve and pamper them. The ego of a chronic relapser is massive. At times, it is deserving of deflation. Get them to do their chores like cleaning their space and cooking their food.
Chronic relapsers need training in honesty. At Solace Sabah, we do this when we get them to give each other feedback in group therapy. The focus on honesty and accountability will keep them in check. Throughout their recovery, these checks and balances are essential for sobriety.
We understand that it is a constant struggle to keep clean. The recommendations are difficult and challenging for a reason. You (Chronic Relapser) are suffering from a relentless illness. Tackling this sickness is a daily affair. The struggle will end. There is a light at the end that will be a life in peace and recovery. There is hope. The strife is worth it. The promise is that by working hard at it, recovery will pan out well for you and your loved ones. Read about the benefits of being sober by clicking here.