Having a slip. Falling off the wagon. Getting back on the sauce. No matter what euphemism you choose, relapsing after a period of sobriety can feel devastating. But should it be considered a failure or it just a temporary setback?
According to Dr. Nasir Naqvi, an MD and PhD at Columbia University, alcoholics and addicts in their first year of sobriety have a relapse rate of about 70 percent. Frankly, those are pretty bleak odds. If there were a 70 percent chance that your plane would go down, you’d probably wait for the next flight.
But alcoholics don’t necessarily have the luxury of waiting for the “right” time to get sober. The recovery process usually happens in fits and starts, and it’s almost never a straight line from hitting the bottle to a life of teetotaling and spiritual bliss.
Andrew, a 51-year-old private addiction counselor from Connecticut, first tried to clean up in 1984 after an ultimatum from his then-wife. He was unsuccessful at abstaining, even just for a few days. His next real go at sobriety was in 1990, when he attended an A.A. meeting in New York, but he continued to use for another year before shipping off to Hazelden. “That was my first actual introduction to 12-step recovery, but I got loaded there,” he says. “I was sober for maybe two or three weeks.”
Kelsey, a 19-year old student and recovering heroin addict from Los Angeles, also had a tough time sticking to abstinence. “The first time I tried to get sober was a month after my 17th birthday,” she says. “My life was awful. I had gotten arrested for burglary and I just couldn’t handle the lifestyle anymore: the physical addiction, the lying, the stealing.” Thinking that physical distance from her dealers would help, she asked her parents to take her to Montana so she could kick. “I ended up getting drunk the whole time I was up there,” she recalls, “in addition to popping the Xanax from the medicine cabinet.” Kelsey was high on heroin within an hour of returning home to L.A.
So what is it, exactly, that triggers a relapse? Both Kelsey and Andrew had physically detoxed for long enough that their cravings for drugs and alcohol were no longer physiological, and they both, at least nominally, wanted to get sober. According to Naqvi, the two most common triggers are social situations and stress. He says that while the specific high-risk situations vary from person to person, “social situations associated with alcohol use, like specific friends or going to certain bars” tend to set off many. But stress, he says, is the major trigger, and it can be translated into negative emotions like fear and anxiety though “over time people get better at managing those emotions that lead to drinking.”
Ilana Baar, a counselor at Austin Recovery in Texas, says that different triggers arise depending on where the person is in the recovery process. “There are specific circumstances that need to be watched out for,” she says. “With someone who’s using or drinking very heavily, often the first stage is acute withdrawal, which is when it’s important to be in a medically supervised environment, or with family and friends. That can be followed by the honeymoon phase—the pink cloud—and one of the dangers then is over-confidence.”
The best way to forestall relapse, according to Naqvi, is to seek out a mental health professional since so many addicts also suffer from other psychological problems like anxiety and depression. He says, “If you have these issues and don’t treat them, the tendency to relapse will be much higher and recovery just doesn’t work as well.” He recommends a three-pronged approach: working a 12-step program, cognitive behavioral therapy, and “motivational interviewing,” which he describes as a therapy that “helps the person move into a stage of motivation to maintain sobriety by helping them to understand consequences and their own ambivalence.”
But what about those unexpected, sneak-attack cravings—the kind that tell you that you just have to have a drink or a bump or a smoke right now? Naqvi advocates something called “riding the wave.” As he explains it, “You think about the craving as something that is not permanent and will eventually go away by learning how to distract yourself and thinking about negative consequences. Then you develop coping skills that help regulate cravings. The goal is for people to discover what they should do when they’re in a high-risk situation and have to refuse alcohol. We also identify the negative coping skills—what we might call social deficits—that people have, like a mood disorder or social anxiety. The overall goal, according to Naqvi, is for people to get better at managing those emotions that lead to drinking.
Andrew was finally able to maintain sobriety for good after getting arrested and heading to another rehab in place of doing time in jail. He had no intention of actually cleaning up. “I thought I could stay in treatment long enough to get out of trouble,” he explains. He ended up staying at the facility for five weeks, leaving when he was kicked out for getting loaded. He was then transferred to a different rehab, and has been sober ever since—for nearly 13 years now. He credits his success this time around to “working steps in the second treatment program, not because I wanted to stay sober but because I was afraid they would send me to jail.” With more than a decade of clean time under his belt, Andrew knows his way around preventing a slip. He says, “I go to a meeting almost every day. I call my sponsor. I have sponsees. I’ve never been without a couple of service commitments a week. I talk to newcomers at meetings. I hand out my number. I have never let up on it.”
Kelsey’s trajectory is similar to Andrew’s, albeit more condensed. Her parents sent her to a rehab in Utah a month after she returned from Montana but she relapsed within hours of her discharge. “I thought heroin was my problem,” she remembers. “I believed I could still drink because it wasn’t heroin. I didn’t see the connection between other drugs and heroin.” Kelsey stayed clean for four more months, and then got high for the last time when she smoked pot after finding it while cleaning out her bedroom.
She’s been sober ever since, for over a year now, and she credits her continued sobriety to A.A. meetings, a network of sober friends, and the fact that she keeps herself busy. So why did sobriety finally stick for Kelsey? She says, “The more times I relapsed—the more in trouble I got with the law or with my family—the more it helped me to stay on track later and do what I had to do. The smaller my world got because of having to go to rehab or be on probation, the easier it was for me to get my life in perspective.”
Both Andrew and Kelsey are chronic relapsers who have managed to maintain consistent sobriety against all the odds. Though is that really accurate? Or is the reason they’re now sober now because of their repeated relapses? Ilana Baar, for one, believes that relapse can actually be “a really beautiful learning opportunity.” Kelsey is grateful for her relapses as she says they pushed her closer to understanding just how sick she had become; she says, “I don’t think relapse should be viewed as a failure. It really helped me.” Andrew echoes the sentiment, always telling his clients and sponsees that no matter what setbacks they face, “they have to keep trying. There is no alternative.”