Chronic Relapse after Treatment Ernie Hooker, NDAC, CADC

Here are Some of the Reasons Patients Relapse Immediately after Treatment 

The patient did not have adequate assessment and treatment of their problems.

Here are some examples:

• There are many possibilities for psychological or mental problems not being assessed.

• Studies report that when alcoholics enter treatment 40 percent of them have brain trauma. Obviously, the lifestyle tends to make this condition more likely. Rarely are patients assessed for brain trauma.

• A decrease in abstract thought for relapsing patients may not have been assessed.

The above are only a few of the possibilities.

• There can be medical problems that may not have been assessed or treated as needed.

• The patient can have severe liver problems that result in temporary dementia or being extremely lethargic.

• The patient may have a history of multiple drug use and/or a longer more complicated history of use than reported.

• The patient may not have been completely detoxed prior to their treatment and consequently cannot benefit fully from the information. Many times patients are discharged before they are prepared for the next stage of their treatment.

For example, the patient had been using alcohol and Valium and the Valium hadn’t been picked up in the assessments. The patient has been detoxed for alcohol but not for Valium. His Valium withdrawal had just begun and was not completed by the time he left treatment.

Or, the patient has been using crank or similar drugs and had a paranoid psychosis as a result of the use. If the psychosis was not assessed and treated, it may be a problem for up to six weeks. In a few cases there is permanent damage.

• The period of withdrawal and craving for marijuana, methadone, Valium, and other similar drugs is almost always significantly underestimated.

It is pretty much guaranteed that the patient will go through the protracted withdrawal syndrome as described in Beyond the Influenceby Katherine Ketcham. This includes neurotransmitter depletion, malnutrition, possible hypoglycemia (which usually is temporary), autonomic nervous system dysfunction, and cortical atrophy. The problems caused can be significantly reduced by proper treatment especially nutrition. The key is to be treated by staff who have the in-depth knowledge of addiction and who have made adequate treatment recommendations.

Some Questions to Answer

After inpatient treatment, does the aftercare provide adequate support to address the patients assessed problems? Is that support for a long enough period of time to expect recovery? It is important to consider if the patient has been involved and agrees with the plan. Is it realistic for this patient? Does it consider his finances and other possible limitations?

If the patient is being treated by other physicians, have they been contacted and any medication they may have prescribed been considered as a possible relapse cause? A very high percentage of patients relapse because they have been prescribed mood altering medications by another physician.

Does the patient have a twelve step sponsor who will support immediate work on the steps? Has he/she been offered contact with Back to Basics education? If Back to Basics educational groups are not available this information can be obtained on the internet.

Other Factors

Many chronic relapsers have never been educated on the nature of grief as a major issue in recovery. Facing the losses caused by the addiction is extremely difficult but avoiding them is always disastrous. The Grief Recovery Handbook from the Grief Recovery Institute is always helpful; their website has a wealth of information.

This is only a short sample outlining some possibilities and a strong recommendation for seeking out staff well-trained specifically in addiction problems. ASAM certified physicians and counselors certified by NAADAC and the state certifying agency are essential. For more information read other articles on my website and read Beyond the Influence by Katherine Ketcham.

Many of those who relapse repeatedly can be traced to a lack of adequate problem assessment and, of course, what is not recognized cannot be treated.