Overcoming an alcohol use disorder is an ongoing process, one which can include setbacks. Many people like to talk about recovery as this linear upward progression of gradually getting better. One day at a time, right? While this may be the case for some, overcoming alcohol abuse disorder more often than not includes setbacks like relapse. It is quite rare for a true alcoholic to simply decide to quit drinking one day, and then never pick up another drink for the rest of their life. A single visit to a 12-step meeting provides enough insight that alcoholics have a disease that can’t simply be “turned off” like a light switch. Staying sober takes a daily commitment, vigilance, and sheer force of will. While it may feel hopeless to see a loved one keep going through alcoholic relapse events, that does not have to be their story forever.
The Importance of Persistence
Loved ones should understand that alcohol use disorder has the capacity to be a chronic relapsing disease for many individuals. That is why persistence is key. While the thought that detox and rehab will “fix” your loved one presents an alluring idea, it rarely plays out that way in reality.
It is uncommon for alcoholics to go to treatment once and never pick up a drink for the rest of their life. More often, people must repeat attempts to quit and go to rehab. If relapse occurs, the individual can learn from that experience and keep trying. The threat of relapse makes aftercare critical to overcome long term problem drinking. But there are millions of alcoholics that have successfully achieved their goal to remain sober for years, even decades.
Alcoholic Relapse Sucks, but It’s Part of the Process
Unfortunately, relapse represents a common thread among people who overcome alcohol problems. But that information contains both warning and hope. An alcoholic relapse event does not represent hope in itself, of course. But the fact that many recovering alcoholics have gotten past relapse events shows a path forward.
Just as people with arthritis or diabetes experience flare-ups of their disease, a relapse may be viewed as a temporary setback rather than a total failure. Some good news: alcoholism can absolutely be managed with the proper care and attention. Professional help sets individuals up for success to prevent alcoholic relapse. Behavioral therapies used in rehab help individuals develop the skills necessary to avoid and overcome triggers. Understanding triggers as warnings also offers a way to further understand how to avoid relapse. So what are the most common relapse triggers?
- Stress. Alcoholics primarily use drinking as a maladaptive coping mechanism. Stress of any kind presents a situation where alcoholics may feel unable to navigate a complicated or unpleasant event effectively. Unfortunately the “solution” of drinking is insidious because it often exacerbates stress rather than alleviating it.
- People and places associated with past drinking. Recovering alcoholics have it pretty tough. Social drinking pervades so much of modern culture that it is difficult to go a day without encountering alcohol in some form. Whether it’s at a grocery store, in an advertisement, or passing the many liquor stores and bars present on any commute, temptation is everywhere. Alcoholics in recovery benefit from making a plan to avoid and/or deal with these types of triggers.
- Ongoing mental health issues. Dual diagnosis describes the intersection between substance use disorder (such as alcoholism) and a mental health disorder. Heavy drinking often goes hand in hand with issues like depression and anxiety. Studies show that people who suffer from alcohol dependence are 2-3 times more likely to suffer from major depression or anxiety over their lifetime. Many treatment programs offer dual diagnosis support since this intersection happens so often.
- Unaddressed trauma. Post-Traumatic Stress Disorder (PTSD) has disturbing residual symptoms for many individuals. These are often difficult to cope with and temporarily alleviated by alcohol as a numbing agent. Unfortunately, drinking tends to make PTSD symptoms worse. Therapists can help individuals work through unaddressed trauma to more healthfully react to PTSD symptoms.
Sobriety Starts with a Choice
As much as it hurts family to accept, only one person can make the decision for an alcoholic to get sober. That choice must come from the alcoholic voluntarily. No amount of outside pressure, shaming, or bullying can force an individual to choose sobriety. It might get them to stop drinking for a while. But ultimately, the choice not to pick up the bottle again has to come from within.
At Blue Coast Behavioral Health, we offer extensive education on the stages of change. This process describes the mental decision-making behind choosing to get clean and sober. The basic process outlined:
- Pre-contemplation
- Contemplation
- Preparation
- Action
- Maintenance
- Relapse
For families worried about an alcoholic who keeps relapsing, understanding the stages of change offers insight to a baffling process. Every alcoholic presents different case circumstances. But chronic relapse often indicates that the individual has not truly progressed past the contemplation stage of change. Going to rehab doesn’t actually indicate that the person arrived at the action stage of change. Often, this “action” is motivated by external pressures and threat of consequence from family, friends, and work.
Individuals can also regress backward if not working a strong program (particularly in outpatient). This vulnerable time often brings on thoughts like, “Well, things have been going really well lately. I should be ok to drink again, and I’ll make sure it’s different this time.” That erroneous train of thought shows up as a very common feature of early recovery. If this is a recurring event, individuals may benefit from certain medications like naltrexone, the monthly Vivitrol injection, acamprosate, and in some cases Antabuse. The efficacy of these medications are monitored through regular treatment checkups with a psychiatrist.
Advice for Creating Boundaries
Addiction is a family disease. Friends and family members of alcoholics suffer in their own ways as they watch the person struggle with a life-threatening drinking problem. Navigating a relationship with someone in active addiction presents many complications. The need for boundaries becomes critical as the alcoholic progresses further into their disease. Though it may seem like love to try and offer support to an alcoholic, any kind of support quickly becomes enabling. The unfortunate reality of many situations requires drastic action to encourage progress through the stages of change. After all, an alcoholic must make the decision to get sober for themselves, but why do so when friends and family accommodate their problematic behavior?
Boundaries offer a way forward when living with an active alcoholic becomes untenable. Establishing boundaries takes strength and often direction from a professional. Therapists provide great tools for creating effective boundaries. Individuals may also seek counsel from other sources including addiction counselors, spiritual leaders, and Al-Anon meetings. Our admissions staff members at Blue Coast Behavioral Health offer free counseling about establishing boundaries over the phone: 714-203-2708
Alcoholic Relapse: Not the Family’s Responsibility
Remember that your loved one is ultimately the one responsible for managing his or her own illness. Getting sober is difficult, takes time, and often repeated efforts after relapse. But although many alcoholics experience failure points during recovery, the process is a marathon, not a sprint. Alcoholic relapse events present learning opportunities to keep going and growing in recovery.
Although alcoholic relapse is not your responsibility, family members do well to stay involved with clinical family visits. Many health providers believe that recovery support from family provides an important piece of the puzzle for long term sobriety. Pay attention to the small ways that your loved one makes an effort in their recovery. Too often families are jaded and mired in resentment from recent memories of alcoholic behavior. A word of appreciation or acknowledgement of how the recovering alcoholic is trying can go a long way.
If you or a loved one is seeking help for an alcohol problem, our counselors are available 24/7 by phone: 714-203-2708
