Why is drug or alcohol relapse so common in India, and how does it come about?
A useful analogy is your house flooding. You leave for the weekend and forget to close the bathtub upstairs. Water overflow runs into the hall. As it falls down the stairs, its splashes reach the living room. When you get back home, you learn that water has soaked your walls, mold has formed, there’s warping in your wooden floors, and they’re peeling.
Your original mistake of forgetting to turn off the water has led to the need to rip up the floors. Moreover, you have to deal with torn out walls. While you may run to turn off the tap (detox), it doesn’t immediately reverse the damage that flooding (alcohol or drugs) has caused to your entire house (whole brain).
If you have gone through rehab, your first year after your recovery can be incredibly daunting. In fact, relapses are more common within this time. The Indian Journal of Psychiatry reports that more than 75 percent of persons with substance use disorders (who receive care) relapse within a year. Here are the top reasons why relapse is so common in India.
1. Sensing or seeing objects of substance or alcohol use disorder
Things that remind you of your old life can trigger relapse in the course of recovery. Seeing someone sip a cocktail in a pub or restaurant, two lovebirds locked in an erotic cuddle, or a whiff of cigarette smoke are some of the reminders that appear to be all over in people’s early stages of sobriety.
The urge to regress into substance use is normal—it’s a familiar habit. While a professionally supervised detox prepares the ground for getting rid of addictive substances from your body, it doesn’t reverse the damage substances have done to your brain. A recovering mind is always vulnerable to relapse.
Both mental and physical triggers can act as setbacks. Mental triggers can include a re-exposure to the stress that instigated the problem, for instance, bad intimate relationships, demanding jobs, and financial problems in the family. Triggers can also stem from past traumatic events such as sexual abuse and physical assault.
Physical triggers can include revisiting places where you used alcohol or drugs, continuing to associate with the friends with whom you abused drugs, objects, for instance, syringes, or even movies and songs.
2. Painful withdrawal symptoms
People who grapple with a substance use disorder often relapse within week one of quitting because of painful withdrawal. If they manage to last for more than a week, the post-acute withdrawal symptoms (which often last from six to 18 months after stopping) are often hard to maneuver through while still maintaining sobriety.
Persons with substance or alcohol use disorders will grapple with varying levels of withdrawal symptoms. The severity of the symptoms will depend mainly on the type of or substance used (or activity addicted to), the amount of use, weather the condition is already chronic, and other illnesses the patient has. Typical withdrawal symptoms include:
• Cold and hot sweats
• Insomnia, confusion, and headaches
• Muscle aches
• Anxiety, heart palpitations, shaking, and tremors
Moreover, withdrawal from benzodiazepines and alcohol can cause respiratory depression, coma, seizures, and even death. Such deadly withdrawal mostly occurs when someone mixes benzos with other opioids or alcohol.
Most Indians who struggle with substance use disorders turn to their activity or substance of choice as a maladaptive coping mechanism. According to the Indian Journal of Community Medicine, people have an increased craving for addictive activities, drug, or alcohol when they grapple with a stressful situation. It is more common for individuals who are used to using the activity or substance as a maladaptive way of coping.
The Annals of the NYAS reports that stress early in life can cause changes in the brain that can increase the possibility of addiction and relapse. The chemicals that your brain secretes when stressed leave a little kiss of destruction behind. The damage can cause an enthusiastic brain response when you take alcohol or a drug of your choice. It offers you a false form of relief.
The idea here is that most people self-soothe with substances, harmful activities, or alcohol to relieve the pain in their minds. It’s a form of medication. While stress can drive you into alcoholism or drug use, it can compel you to come back to using substances, even when you no longer need or want to.
If you used substances or alcohol to medicate stress, you train your brain to crave drugs when another stressful event hits. The craving emanates from deep inside your mind (far below your conscious thoughts). They can be challenging for you to control. When such yearnings for drugs hit in recovery, relapse seems almost inevitable.
4. Unrealistic expectations
When you are in recovery, your anticipation might be that things will soon change drastically for the better. However, it would be best if you manage your expectations. Recovery is a long and delicate journey whose goal is not perfection but progress.
You set yourself up for failure when you have unrealistic expectations such as:
• Expecting MAT therapy and recovery to be a walk in the park
• Expecting treatment to be a swift process and imagining you’ll feel better immediately you join rehab.
• Ignorance of the need for determination and hard work in recovery
• Thinking you can recover without professional help
• Imposing perfectionist ideas on your recovery process and punishing yourself for falling short of such impeccable expectations
• Assuming that your family will quickly regain their trust in you because you have joined rehab—rejuvenating the lost love and repairing the damage to intimate relationships often take effort and time
When you create a long list of impossible demands for sobriety, you use it as an excuse to use or drink again. You set yourself up for frustrations that often bring about negative emotions and regrets that can jeopardize your recovery.
5. Mental health issues
A substance and alcohol use disorder is a disease in itself, but there are often many problems underlying the condition. Without treating the underlying condition and simply quitting the use, it is like sweeping under the carpet.
Most people relapse because they detox without addressing the hidden anxiety, personality disorder, depression, PTSD (post-traumatic stress disorder), among other mental issues.
As with substance use disorders, mental health conditions typically need long-term professional care to sustain sobriety. If you don’t know how to address your mental disorders or fail to address them adequately, they can prompt relapse.
Persons grappling with alcohol or substance use disorders aren’t used to experiencing mental disorders without turning to their substance of choice as the primary coping mechanism.
Fortunately, with proper therapy, and in some instances, with the aid of prescribed medications, you can win your battle against co-occurring disorders or dual diagnosis.
The bottom line
If you think that you are slowly sleeping back into drug or alcohol abuse or are concerned that a loved one might be, don’t hesitate to seek professional help. Call your therapist to consider the possibility of temporarily “ramping up” any treatment plan your therapist might have scheduled. You can as well join a peer support group to learn from others and share your struggles.
There isn’t shame in taking proactive measures to prevent relapse or calling for an adjustment to your treatment plan. You need to seek the expert help you need to stay on the right track. Relapse doesn’t necessarily mean your treatment has failed. You are navigating in unfamiliar waters. However, with continued treatment and professional support, you can build robust defenses against any trigger.