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Why Didn’t Rehab Work the First Time?

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Risk Factors for Addiction Relapse

An Addiction journal study in 2006 noted that short-term relapse rates might exceed 80% for untreated alcohol abusers while the rate of relapse for addicts who went to rehab ranges from 20% and 50%. Similarly, an analysis of the Drug Abuse Treatment Outcome Studies (DATOS) published by the Psychology of Addictive Behaviors journal in 1997 put the average relapse rate at 40% to 60% depending on various key factors. Rehab clearly increases the likelihood of a successful recovery, but about half of all recovering addicts still experience setbacks and struggles, especially in the first year after treatment. There are several reasons why rehab might not work the first time, but recovering addicts should not give up.

Risk Factors for Addiction Relapse

The National Institute on Drug Abuse (NIDA) in 2010 suggests that relapse is likely for many recovering addicts. A patient’s level of engagement naturally affects recovery outcomes, but several other risk factors can also contribute to relapse including the following:

Risk Factors for Addiction Relapse
  • Co-occurring mental health disorders
  • Severity and length of the addiction
  • High levels of stress and drug cravings
  • Unemployment and family conflict
  • The type of substance being abused
  • The duration of the rehab treatment
  • Negative life events and poor coping skills
  • Chronic pain (for painkiller addicts)
  • Insomnia and anxiety (for sedative addicts)

In 2011 Current Psychiatry Reports also noted several biological risk factors including brain atrophy in the medial frontal regions, hyperactivity of the anterior cingulate and certain measures of adrenal sensitivity and serum brain-derived neurotrophic factor. Many people do not realize that addiction involves neurobiological changes and genetic vulnerabilities, which contribute to its classification as a chronic disease.

Addiction Is a Chronic Disease

In the past medical professionals often treated addiction as an acute disorder that is curable with a short course of action, but clinical studies have reclassified addiction as a chronic disease with persistent and long-lasting symptoms. In 2000 the Journal of the American Medical Association concluded that addiction relapse rates should be compared to other chronic conditions when determining treatment efficacies. The study compared addiction to three other chronic illnesses – type 2 diabetes, hypertension and asthma – and highlighted the similarities including the following:

  • Thirty to 50 percent of adult diabetes patients experience a relapse of the disease.
  • Fifty to 70 percent of asthma and hypertension patients have symptoms return.
  • Addiction relapse rates fall within a similar range at 40% to 60%.
  • Forty percent of diabetes patients do not fully adhere to medication regimens.
  • Sixty percent of hypertension and asthma patients also fell short of strict medication use.
  • Seventy percent of patients for all three diseases did not adhere to dietary and/or behavioral changes.
  • Genetics played a role with similar heritability rates for addiction and other illnesses.

The study underscored that the rate of relapse in recovering addicts is similar to that of patients recovering from other chronic conditions. Furthermore, people with these conditions were more likely to experience setbacks if they did not follow the medical, dietary and behavioral guidelines. In the same way addiction relapse rates were higher for people who had shorter stays in treatment and failed to engage in aftercare services, which highlights the importance of implementing recovery therapies.

Addiction Support Services

NIDA published a Relapse Prevention manual in 1994 that stressed the importance of social support and lifestyle changes while the Addiction journal in 2002 says the chronic nature of addiction necessitates continuing care. There are several types of support services that provide invaluable help including the following:

  • Local recovery support groups and 12-step programs
  • Recovery sponsors and partners in the program
  • Mental health counselors and/or the family doctor
  • Friends and family willing to provide active support
  • Community groups that promote sober activities
  • Hobbies that promote positive mental health

Relapse is not a negative reflection on the individual or the rehab program, but it does need to be addressed. If a setback does occur, speak with your recovery sponsor, the rehab center or someone in your support network immediately. Be honest about the relapse, and recognize that it may be a signal that treatment needs to be reinstated, adjusted and/or enhanced.

Addiction Treatment After Relapse

A Treatment Episode Data Set (TEDS) report in 2011 found that nearly 57% of rehab patients had been in treatment before, and 23% had been in treatment at least three other times. A 2010 TEDS study also found that almost 29% of readmissions involved patients who had not used in the past month, which suggests an effort to preempt relapse. Rehab centers often treat readmitted patients with previously applied therapies, but the relapse can also help rehab centers make treatment adjustments, which can potentially include the following:

  • Identify substance-cravings cues that were previously missed.
  • Change the type of treatment (e.g., from outpatient to inpatient).
  • Recognize misjudgments, mistakes and recovery omissions.
  • Better train loved ones on how they can support recovery.
  • Strategize how to make the necessary adjustments.

NIDA cited statistics in 2008 that show relapse risk decreases with time. The rate of relapse drops to 34% for recovering addicts who remain sober for one to three years and only 14% relapse after three years of sustained abstinence.

Addiction Help Center

Do you or a loved one need recovery help? Our admissions coordinators are available to answer questions and provide support 24 hours a day, and they can even check health insurance plans for benefits. Please call our toll-free helpline now.

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