Unfortunately, not enough attention is paid to making sure that everyone understands that this is a difficult and challenging time when a large number of clients relapse. Even among those who do recognize the challenges of re-entry, many do not take the steps necessary to ensure the best chance at sustained recovery. While many people can tell you that the first 90 days post-treatment is a vulnerable time, few seem to offer sound advice about how to maximize the chance for success.
There are essentially four major reasons why those who successfully complete a course of residential treatment relapse:
- Upon return, they do not participate in a continuing program of recovery;
- AA or other 12-step program, continuing relapse prevention treatment, sober living, therapy with an addiction specialist, etc…
- They try to return to a high level of functioning too quickly;
- work, parenting, dating, or other high-pressured responsibilities.
- They continue to associate with substance using peers in environments where drugs and other temptations or “triggers” are readily available.
- socializing with substance using peers, hanging around bars, parties, etc…
- Support systems expect too much of them upon return, and expectations for sustained sobriety in the context of high functioning are unrealistic.
Make no mistake, this is a huge problem. The fact is that in many cases, identifying an addictive disorder and making a recommendation for residential treatment is the (relatively) easy part. The challenge is to convince not only the client, but also their entire support system (family, friends, teachers, bosses, etc…) that their problem will be a continual one to be managed and supported, not cured.
As clinicians, I believe that we have a duty not only to our clients, but also to their support systems (relatives, partners, teachers, coaches, bosses, etc…), to educate them about the importance of sustained recovery and the challenges of re-entry, as well as ways in which they can maximize the chance of achieving long-term sobriety.
I Just Returned Home From Treatment – Why Is Everything So Difficult?
When a car breaks down, the expectation is that the mechanic will diagnose and (hopefully) fix the problem, we receive an invoice, pay the bill, take back the car and life goes on. Unfortunately, when a person goes away to rehab for treatment of an addictive disorder, many people – including the client – often have a similar expectation. Nothing could be farther from the truth. As I discussed in the last section, completion of a stint at a residential treatment facility should really be thought of as more like a starting point rather than the end of a difficult process. In this section, I will address one of the common challenges that families face when a loved one returns home.
As an example, consider the experience of buying, and moving into a new home. Anyone who has ever purchased a home is familiar with the issue: During the first several months after moving in, things begin to break. The doorknobs fall off, toilets run, door hinges squeak and floorboards come loose. Many a new owner has experienced a feeling of “buyer’s remorse” left to wonder, “what is the problem? I just spent all of this money, had the house inspected…why isn’t it perfect? Is the house possessed by evil spirits?” Not exactly. A logical explanation is that the family who previously occupied the home spent years acting and behaving in certain ways (e.g. opening cabinets, turning faucets, walking, flushing toilets, etc…) which the house “got used to”. When a new family interacts with the home in a different way, the result is that certain “weak” points of the home may malfunction or break.
I particularly like this example because it addresses many of the same challenges that occur when a loved one — who has been away in treatment for 30, 60, or 90+ days — returns home. Everyone is excited about the prospect of a new and healthy beginning, but few are prepared to handle the challenges that arise. Much in the same way that a new home is “used to the old ways” and “breaks” when new behaviors are introduced, family systems often “bend and break” under the stress of the new and healthy behaviors that a returning loved one introduces. It is pretty much standard issue in my practice that within weeks to months of a person returning home from treatment, family members report increased levels of stress, and concern about the difficulties they are having. Marriages may suffer, parental relationships can deteriorate and friendships definitely change. The good news is that while challenges should be expected, they do not have to mean an interminable period of difficulty. Clients, their families, friends and other support systems need to be aware that re-entry will likely mean a need to re-adjust to the new behaviors and expectations that come with sobriety and managing the chronic relapsing-remitting disease of addiction. With time and the right work on the part of the loved one and the family, (e.g. therapy, al-anon, etc…) these re-adjustments can be useful and hopefully lead not only to more fulfilling relationships, but also to a period of sustained recovery.