Reducing Relapse After Rehab

Relapse Prevention after Rehab:  Two Key Reflections for Young Adults and Their Families

Young adults considering 28 day rehab programs have a lot on their plate to consider, as do parents, supporting family members and friends. In addition to the emotional heartache, the financial expense, disruption to work-life and family dynamics, there is the looming question about relapse after returning home. Particularly common for young adults is a relapse within weeks, days, and sadly, even within 24 hours of returning home.  When this happens it makes families wonder if the whole effort was a complete waste of resources.

The following are two simple reflections for parents, supporters as well as the young adult considering treatment and long term recovery – reflections best considered before even entering a rehab center. In some cases these could make all the difference in the long term sobriety and recovery success for a young adult after completing a 28 day inpatient rehab program.

1) Consider a long term or permanent relocation  The social sciences inform us that human experience is deeply influenced by environmental cues and triggers. This is exponentially true for individuals trying to recover from addiction, because of biological, psychological and other stressors that exist in the context of transitioning home. Coming home should be a transition from a level of high support to a level of medium support, as it can be like a step off a 20 foot embankment onto hard ground below. Nevertheless, many patients come home with an entirely inadequate relapse prevention plan and virtually no real-time practice under pressure. Think of it this way – a day at inpatient rehab might contain between one and five internal cues or triggers to use a substance of choice with virtually no access to the substance of choice. By sharp contrast, once home, a typical day might contain between one hundred and three hundred cues and triggers to use substances, and twenty viable opportunities to access one’s substance of choice. Leaving rehab and coming home should be “engineered for success”, but often it is just the opposite – familiar faces who use, familiar sights, sounds and smells, familiar routines, familiar feelings – they all return – because they have been rehearsed for years. They come back quick and hard and can often unravel the best 28 day program within a few short days or even hours.

Critics argue that the solution is not geographical. While geographical moves don’t solve everything they certainly can provide a much needed break from cues and triggers, which buys a person time to adapt. A geographic move also provides the opportunity to restructure relationships, the next relapse prevention item worthy of reflection in this article.

2) Invest heavily in reassessment of all close relationships.   One of the hardest challenges facing any addicted person is the enormous psychological strength necessary to put distance between oneself and those who may have been friends while contributing to the substance use problem. No one likes to let a friend down. Even if the friend is blatantly encouraging substance use it can be incredibly difficult for some people to make that necessary clean break.

The psychological preparation is amplified if the individual has been involved for a long time with other substance users, and even more so if those users are lovers or direct family members. Young adults in particular may have even greater challenges as they might have a need to break off association with five, ten or more people. Generally speaking it is rare for a 28 treatment period to equip someone with the level of desire and commitment necessary for such a transition, not to mention the confidence and skill development necessary to begin replacing unhealthy relationships with healthy ones. This fact underscores the importance of the first point.  If the addicted person is not ready to tackle critical relational changes, it’s okay and normal; but they would do well to also consider if it is best to relocate for whatever time period is necessary to prepare for such changes.

Critics here would ask – “what about a job?”  “What about family support?” “How can a geographical move change internal dynamics?” These are great questions and though not easily answered, answers exist. Detailed discussion of these topics is beyond the scope of this article but families who are planning for a successful rehab effort are advised to look just as closely at transitional living facilities and sober community alternatives – not just the rehab center itself.  In a professionally designed and supervised transitional living environment, individuals can find tremendous therapeutic, employment, and social resources that provide rich opportunities to succeed in long term recovery.

Brian T. Davis, LISW-S, SAP is a substance abuse professional living in Columbus, Ohio and practicing for the past 20 years at Directions Counseling Group. He is the founder and CEO of Directions Counseling Group and New Directions Substance and Behavioral Services.