Why do so many people relapse in early recovery?
The rate of relapse during the first year after treatment ranges from 37 to 56 percent, but the numbers are easier to understand once we take a look at what people face when they leave the safety of residential treatment.
Let’s dig in…
John successfully completed 90 days in a residential treatment facility. When discharged, he was committed to leaving a life of heroin use behind. For the first time in a long time, he was hopeful about the future.
As he worked to establish a new life, John’s hopes quickly sank. Due to his drug habit, there was no money in his bank account and he had no job. Before getting treatment, he was living with “friends.” He knew he couldn’t go back to that environment if he wanted to stay sober. That meant he also had no place to live. John quickly discovered it was difficult to get a job with his history (and with no home address to put on applications). He felt stuck in a cycle of ‘no money and no means to get any.’
Maybe he could try staying at his old place…
Researchers found that unmet basic needs (financial stability, a job, a place to live) are a top individual barrier for recovery post-treatment.
Kenny was done with drinking. After four months of residential treatment, he returned home with a new perspective and new resolve. Unfortunately, not everyone shared his new outlook.
Kenny’s alcoholism placed a huge strain on his marriage, his friendships and his work relationships. He burned a lot of bridges and now felt isolated. He had no friends – or at least none who didn’t abuse drugs or alcohol. He found it hard to talk to his wife about the cravings (or anything, for that matter). He felt he had nowhere to turn in the midst of his struggles. It became more and more tempting to turn back to alcohol…
Interpersonal barriers are a big factor in relapse among those attempting to return to their lives after treatment. (Lack of support network, strained relationships and friends who use drugs.)
Leaving the in-patient treatment center, Liam was 60 days sober. He hadn’t taken a painkiller in two months. He knew it would be a challenge to steer clear of them, but he was willing to take steps to in the right direction. The first of these was follow-up care.
Liam called to sign up for out-patient counseling sessions and discovered a very long waiting list. He wasn’t too surprised; during his residential treatment, it had been difficult to get an individual appointment with a doctor. One day, a mandatory support group meeting had been cancelled because there was no one to lead it.
Liam continued to follow up with the center, but felt he was getting nowhere. He wondered if he would be able to stay sober without the follow-up care that he knew was such an important part of recovery…
A common organizational barrier in early recovery can be the lack of availability in outpatient treatment programs.
Gary’s cousin gave him a ride home when he was discharged from the treatment facility. As he walked to his front door, he glanced around the block. Nothing had changed in the past six months.
Gary saw his old dealer on the stoop four doors down. He heard shouts across the street. His cousin told him there had been another shooting a couple blocks away the night before. As he took all this in, Gary’s hopes of long-term sobriety began to sink.
How was he going to stay sober living in a place like this?
Returning to stressful neighborhoods is a top community barrier to those leaving treatment.
Paul’s social worker spent many hours trying to find a good place for him to live once out of treatment. They finally had to settle on a halfway house – one they both knew wasn’t ideal.
The halfway house didn’t provide support specific to substance abuse, and it brought Paul to a neighborhood with few other resources he needed. But there was simply no other place for him to go. His counselor said she would keep looking.
Meanwhile, Paul hoped he could remain in recovery through this tough transition…
For those completing residential treatment, a lack of housing for those with substance use problems is a common policy barrier.
Why Aren’t We Setting People Up for Success?
Facing these difficult individual, interpersonal, organizational, community and policy barriers, those in early recovery often relapse. With each of these challenges in mind, it’s actually pretty surprising that the relapse rate isn’t higher.
Dr. Jennifer Manuel, PhD, who was part of a research team that examined these barriers, notes:
“What these results show is that the primary areas of intervention needed for these individuals include access to stable housing and employment, aftercare services and positive support networks; expanded discharge planning services and transitional assistance, and funding to address gaps in service delivery and meet individuals’ basic needs. These findings suggest the importance of both informal and formal supports to reinforce and continue progress made in residential treatment.”
Additional Reading: Culture Shock – 5 Things to Expect Once You’re Home from Rehab
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