Drug Relapse Really Is Preventable

An estimated 40 to 60% of people with addiction relapse, but author and clinician Shawn Leadem, LCSW, CSAT, CMAT, has a message of hope: “Relapse doesn’t have to be part of your story.” Together with his father and co-author, John Leadem, LCSW, CSAT-S, CMAT, Shawn compiled insights, practice wisdom, anecdotes and practical tools for creating a personalized relapse prevention plan in their book “An Ounce of Prevention: A Course in Relapse Prevention.” “There is no judgment when relapse is chosen as an alternative to living through discomfort,” Shawn says. “But it’s important to realize it’s not enough to ‘get back on the horse.’ Relapse is not like falling off a horse, or what the seniors in the addiction recovery industry would call the ‘water wagon.’ It is usually the rider and not the horse that is the problem. The problem is in the way you were riding the horse or supporting your sobriety.” The Leadems’ perspective is controversial in some recovery and professional communities. While they are supportive of any plan that will lessen the painful consequences of addiction, they are not harm reductionists. Furthermore, they believe that relapsing is nothing like spilling milk and that there is plenty to cry about. Rather than reassuring people that relapse is a normal part of the addiction recovery process, Shawn says, “Relapse is totally preventable. It isn’t part of recovery; it’s part of active sickness.” This philosophy is informed by decades of personal and professional experience gathered by Shawn and his father. “I have a deep affinity for addicted individuals and their loved ones, as well as those profoundly touched by trauma,” Shawn says. As an infant, Shawn had a life-threatening congenital heart defect that required invasive medical intervention, which resulted in trauma. “I later found myself feeling violated and enraged with little understanding as to why,” he recalls. “I pushed away the people who could’ve helped me heal, and the fear and pain got bigger.” Shawn discovered his drug of choice, which eased the pain in the beginning and then stopped working. It wasn’t until he was emotionally stabilized in his 20s that he could begin working through his early-life trauma and develop healthier coping tools. By his early 20s, Shawn had “been to way too many funerals” in his family system due to various forms of addiction. His father, John, spent 40 years watching people come and go in 12-step communities and began to recognize patterns in feelings and events leading up to drug relapse. Here are two of the Leadems’ core discoveries about drug relapse:

#1 Relapse is a process, not an event.

In “An Ounce of Prevention,” the Leadems offer therapeutic lessons so that people with addiction can “see relapse coming” and take action to stop it. They explore the anatomy of the drug relapse process and the issues that make people vulnerable to relapse. They describe the following phases of drug relapse:

• Uncomfortable feelings – People relapse for one reason: to change the way they feel. Addicts return to their drug of choice because they have chosen to not address uncomfortable feelings, such as anger, fear, love and affection, sufficiently or in healthy ways.
• Time travel – This is a physical, emotional and intellectual phenomenon that can occur when someone encounters an emotional stressor, which is intensified by previous life experiences.
• Fragmentation – Fragmentation is the process in which the way we think, feel, speak and act does not match up. During this phase of relapse, the person will present a distorted picture of who they are and what they are trying to communicate, which can increase their risk for drug relapse.
• Gathering justification – The addicted person blames other people and situations in an attempt to make it OK to relapse. Since the conflict is mostly internal, this phase often goes undetected by others.
• Eliminating the witnesses – The addicted person doesn’t want to acknowledge that they’re in danger, so they push others away. Other people’s input and concern reminds them where the relapse process is taking them.
• Dry drunk – This phenomenon occurs when someone has stopped using alcohol or other drugs but still thinks and acts the same way they did during active addiction. Relapse is likely unless the person addresses the underlying issues that led to substance abuse.
• Relapse – The addict has made the decision to return to their drug(s) of choice.

Each phase of drug relapse has cognitive, emotional, spiritual and behavioral symptoms. “Every individual is unique and so are their relapse symptoms,” Shawn says. “Our goal is to guide people through a series of tasks so they’ll know what their individual relapse process looks like.”

#2 Drug relapse can be identified and prevented.

“Because relapse is a process, people can find ways to cope with discomfort prior to returning to their drug of choice,” says Shawn. In their book, the Leadems list over 70 drug relapse symptoms along with corresponding interventions to manage those symptoms. Next, readers identify the obstacles that have gotten in the way of eliminating their symptoms. For example, in the “eliminating the witnesses” phase, one of Shawn’s symptoms was cutting out people who raised his level of internal awareness by using sarcasm. “I used sarcasm as a buffer,” he recalls. “People would back away from me so I could avoid getting close without completely burning a bridge.” An obstacle he faced is the fear that if he let his guard down, people would start mistreating him like they did when he was growing up. Experiences such as these taught Shawn that it is critically important to overcome obstacles so people can deal with relapse symptoms effectively. Since the risk of relapse is highest in the first 90 days of sobriety, the Leadems guide people to project 90 days into the future and develop specific plans around how they’ll cope with any uncomfortable people, situations, events or feelings they’ll experience. “If the anniversary of your father’s death is approaching and you’ve never made it through one sober,” says Shawn, “it’s important to have a plan based on everything you’ve learned about your particular symptoms to avoid resorting to your drug of choice.” The most challenging part of creating a relapse prevention plan is figuring out which interventions to use for each symptom. “People often say ‘just do the next right thing,’ but it’s hard to know what the next right thing is,” Shawn says. “I can identify sarcasm but that doesn’t tell me how to stop doing it.” The Leadems provide a menu of interventions people can try until they figure out what works best for them. They also guide people to find new interventions that are unique to them so they can manage stress beyond the first 90 days.

Relapse Prevention Tips for Families

Shawn likens addiction to an earthquake. “If you’re in striking distance, you’re going to be deeply impacted by it,” he says. “Relapse hurts everyone who is in the epicenter.” The Leadems, recognizing the heartbreak and suffering families of addicts experience, advise loved ones to: Be part of the plan. Many people use “An Ounce of Prevention” with their sponsor, treatment team or on their own, but it can also be effective to work through it with a spouse or loved one. “We don’t promote that a loved or spouse should assume the role of a guardian or source of authority. But they can go through the course together and understand the completed relapse prevention plan so that they know when their loved one is heading for trouble before their partner even sees it,” says Shawn. “If the addicted person is honest and committed and lets you in, you’ll see relapse coming from a mile away by working as a team.” Heal your wounds. “In the mid to late 70s, the term codependency came into vogue,” Shawn explains. “This term suggests that family members are somehow responsible for, or as addicted as, their addicted loved one. We see it differently. The unhealthy fear and powerlessness that loved ones experience is a form of trauma – they are injured in both large and small ways.” Rather than feeling guilty, loved ones need their own recovery process that factors in the trauma they’ve endured and helps them address their own unhealthy coping strategies. For many people, the Leadems’ approach to relapse prevention is freeing. Relapse is entirely preventable and there’s a roadmap to guide you through. With a plan in place, you can start your recovery with hope and healthy self-confidence.