Relapse Isn’t a Willpower Problem

Relapse is not due to self-control, but a mechanism within the brain that is not under conscious control.

A common misconception is that if an addict relapses, they lack the self-control needed for abstinence. Some people believe addicts are lost causes who are never going to maintain their recovery. But research studies are proving these stigmas wrong.

Although the National Institute on Drug Abuse says 40-60% of alcoholics and addicts relapse, one study done for the National Institute on Alcohol Abuse and Alcoholism has concluded 90% of people will relapse in the first four years in recovery.

Anna Rose Childress, a professor at the University of Pennsylvania School of Medicine, says, “The tendency to relapse is part of the disorder. It’s not a failure of treatment.”

What makes it so hard to avoid relapse?

Within our brain, there is a reward and motivation circuit that is activated when we engage in pleasurable experiences such as eating or sex. Just like when a certain smell makes you hungry or an attractive image “turns you on,” drugs can activate this circuit.

If a certain stimulus is introduced which makes you feel the need to engage in a pleasurable behavior, we call the stimulus a cue and the feeling is a craving.

Cues can be anything within the environment that might remind an individual of using drugs or alcohol. They can be in the form of a smell, sights, sounds and even emotions.

Naturally, we learn how to inhibit, or ignore, the cravings which may produce a negative consequence. We reason with ourselves that eating every time we have a craving would be unhealthy or acting out our every sexual desire would be socially unacceptable.

HBO’s documentary ‘Addiction’ highlights research that has been done on individuals with an addiction. They are hooked up to a machine that produces images of their brain’s activity. Then, a stimulus is shown for a period of time too short for them to consciously acknowledge it. In other words, a picture flashes but they cannot even perceive what it was.

Brain imagery shows that when introduced with pictures of drug use, there is increased activity within the area of the brain that receives cues (the experimenters contrast this by showing that pictures unrelated to drug use do not increase activity in this area). Humans react physiologically to a cue before they even know it.

There are a few different variables that may make drug cravings harder than others to inhibit:

  • Addictiveness—Drugs and alcohol produce a greater “reward,” or high, in our brain than other pleasurable behaviors making them harder to resist.
  • Age of Onset—Strong inhibition of cravings develop with age. Adolescent brains are still growing and developing. If drugs or alcohol are used in adolescence, the inhibition of cravings may be weaker.
  • Brain Chemistry—Although more evidence is needed to support this claim, research has implied that some drugs can actually change the chemistry of the brain, weakening the inhibitory area’s (frontal lobe) function.

It’s not that addicts don’t want to recover. They do. But our brain continually tricks us into thinking a behavior is rewarding regardless of its consequences. Think of it like being told you cannot eat sweets or have sex for the rest of your life. Probably not so easy, huh?

What can be done to attempt to avoid relapse?

After rehab, addicts feel prepared to go out and lead a life free of drugs and alcohol. But most are not prepared to re-enter the life they left behind, filled with reminders of their drug use. Whether it’s the street they used to buy drugs on, the smell of a candle they used to light after using or the voice of the person they often used with, relapse can be inevitable.

An important part of recovery is identifying the triggers in life so the craving can be expected. A good rehab will work with addicts on managing the cravings. They will teach several behavioral techniques such as distracting yourself during a craving, even for a few minutes, as urges are generally short-lived.

Sometimes even behavioral techniques cannot reduce a strong, overwhelming urge to use drugs and alcohol. Medications have been developed to try and reduce cravings, but much time and effort may still be needed to perfect them.

Terry Cronin (LCADC, BRI II) is the Vice President of Marketing at Advanced Health and Education, a drug and alcohol rehab in Eatontown, NJ. Terry has been in the field for almost 30 years. The facility offers a variety of treatment programs for adults, adolescents and professionals. To learn more, visit their website or email Terry at terry@advhealth.com.

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