Addiction is a chronic relapsing disorder, thereby making the prevention of relapse one of the critical elements of effective treatment for alcohol and other drug (AOD) abuse. Studies have shown that 54 percent of all alcohol and other drug abuse patients can be expected to relapse, and that 61 percent of that number will have multiple periods of relapse. It is not unusual for addicts to relapse within one month following treatment, nor is it unusual for addicts to relapse 12 months after treatment; 47 percent will relapse within the first year after treatment (Simpson, Joe & Lehman 1986). Although relapse is a symptom of addiction, it is preventable. A key factor in preventing relapse is improved social adjustment (Joe et al. 1985a). The poor social adjustment by criminal offenders makes them especially prone to relapse and to associated criminal behavior.
Understanding Relapse
Relapse does not occur within a vacuum. There are many contributing factors, as well as identifiable evidence and warning signs which indicate that a patient may be in danger of returning to substance abuse. Relapse can be understood as not only the actual return to the pattern of substance abuse, but also as the process during which indicators appear prior to the patient's resumption of substance use (Daley, 1987). Relapse, however, is not an automatic sentence to a lifetime of substance abuse for an individual. Studies of lifelong patterns of recovery and relapse indicate that approximately one-third of patients achieve permanent abstinence through their first serious attempt at recovery. Another third have brief relapse episodes which eventually result in long-term abstinence. An additional one-third have chronic relapses which result in eventual recovery from chemical addiction (Gorski, Kelley & Havens, 1993). Because relapse is a common occurrence during the process of substance abuse recovery, it is imperative that it be examined carefully. Treating the disease of AOD abuse is not possible without a thorough understanding of the role that relapse prevention plays. Whether or not treatment and criminal justice personnel provide initial treatment services, these personnel have a significant opportunity and responsibility to intervene with recovering persons when they recognize signs of relapse. Some of the skills required include assessment, education, confrontation of denial, brokering of community resources, and building support systems. In order for relapse prevention to be successful, effective systems coordination is necessary. This involves coordination and communication between various agencies and systems. Community treatment programs must work cooperatively to ensure that relapse prevention programming is an integral part of treatment for all patients Several situations may lead to relapse, such as social and peer pressure or anxiety and depression. Studies have indicated that the highest proportion of high-risk situations for alcoholics involve interpersonal negative emotional states, while the highest proportion of high-risk situations reported by heroin addicts involves social pressure. (Marlatt & Gordon, 1985).
Contributing Factors
An understanding of some of the personal factors which may contribute to substance abuse relapse is useful in any discussion of relapse prevention. These may include (Peters, 1993): inadequate skills to deal with social pressure to use substances; frequent exposure to "high-risk situations" that have led to drug or alcohol use in the past; physical or psychological reminders of past drug or alcohol use (e.g., drug paraphernalia, drug-using friends, money); inadequate skills to deal with interpersonal conflict or negative emotions; desires to test personal control over drug or alcohol use; and recurrent thoughts or physical desires to use drugs or alcohol.
Drug and alcohol addiction is a chronic and relapsing condition. Recovery requires changes in attitudes, behaviors, and values. Because of these issues, recovery is not a static condition; it is an ongoing process. Relapse occurs when attitudes and behaviors revert to ones similar to those exhibited when the person was actively using drugs or alcohol. Although relapse can occur at any time, it is more likely earlier in the recovery process. At this stage, habits and attitudes needed for continued sobriety, skills required to replace substance use, and identity with positive peers are not firmly entrenched (Nowinski, 1990).