Should we expect Relapse when our loved ones get Rehabilitation for chemical dependency?

When my son entered a 12-Step rehabilitation program after 19 months of using, I was naively thinking 30 days and he’d be back to normal. There was just no way he would use again, it was such a waste of his young years, and surely he saw this. Well, not only did he relapse WHILE in rehab, he subsequently relapsed many times over. I heard others say that with recovery comes relapse. This helped me accept unfavorable outcomes and not be so disappointed, angry or resentful. Later someone shared that relapse expectations can be dangerous and that perhaps I should not expect it or justify it. Think about the addict who may rationalize as do I: “Craig has relapsed a bunch of times before he made it, so what if I have a drink or two.”

What is minimized is that the last time Sabrina relapsed, she went into a coma and never came back; the last time James relapsed, his drug induced high for 3 days left a trail of armed robbery and arrest. The last time Joe relapsed, he hit a pedestrian while driving under the influence, and Sally? She nearly died from insulin shock, no longer in touch with her blood sugar monitoring.

Having this brought to my attention changed my behavior and attitude towards expecting relapse.  Addiction is a deadly serious disease and any attempts to smooth things over, allow or assist the addict to justify relapse while in my sphere of influence cannot be tolerated.  I will not expect it, but I can learn to accept it.  And with love and prayer, a program of recovery from co-dependency, I have faith that a Power, greater than me, will guide us all toward a program of recovery.

Say What You Mean and Mean What You Say

There’s a saying that has been very helpful along my journey through my daughters struggle with addiction – ‘Say what you mean, mean what you say but don’t say it mean’. Many times the first part ‘say what you mean’ is the easiest. I can often express what I mean to say, even in the heat of the moment when I’m upset or stressed. The second part ‘mean what you say’ is where the challenge starts for me. I’ll give an example. Early in the journey when my daughter was active in her addiction she had gotten out of rehabilitation and was going into a sober living house. I said what I meant, ‘You need to have a plan if you relapse and use drugs/alcohol again because coming home is not an option’. I truly meant this and I knew it was what was best for her. ‘Mean what you say’ is where you hold your loved one accountable to the consequences of their actions. Those consequences are among the very things that can help someone struggling with addiction to seek recovery.
I remember at one point early in my daughter’s journey while she was living in a sober living house that she called me late one night. She said, “I got kicked out, I messed up, I need to come home, I have nowhere to go…’. Short of getting a call that your loved one has been hurt or worse, this was the call we parents dread when we have said coming home is not an option. This happened quite a few years ago and I have learned so much since then about how the most loving thing you can do is stick to what you said. Late that night I couldn’t bear the thought of where my daughter would go or what might happen to her and I let her come home. Five days later she drove her car while seriously intoxicated and crashed into a tree. By the grace of God, she survived. I had been gently coached by a parent who had been through this when I told him that I let her come home. He said, “Your very actions to rescue your daughter from the consequence of her action may very well kill her one day”. While this seemed harsh at the time – it was 2 days before the accident. His words haunted me, he was so right. I did not hold her accountable due to my fears. I became very resolved from that moment on to ‘Say what I mean, mean what I say and don’t say it mean’ and it has made all the difference in our respective recoveries.

Forewarned is forearmed: little-known causes of relapse

5820 Chestnut Ave Orangevale-small-003-21-003-666x444-72dpiThis is a guest post from John Perry, a co-founder of Clean & Sober Recovery Services located near Sacramento, California.

It’s an indescribable relief when a loved one enters treatment where they can gain the skills and tools of recovery. And while we know that treatment offers the choice of life free from drugs or alcohol, it’s important to understand that addiction is a chronic, lifetime disease that doesn’t simply go away. For example, here are some little-known vulnerabilities that persist after treatment:

Sometimes people think, “Pills were my problem, but I can still have a glass of wine.” It doesn’t work that way: Substance use disorder is a brain disease, and people who have become dependent upon alcohol or other drugs cannot take any mood-or mind-altering substances.

A relapse can be triggered by substances that aren’t even on the radar screen. The hidden wine in the fish sauce can set the wheels of relapse in motion, even though the person in recovery didn’t want it or even notice it.

It’s essential to be vigilant during and after medical treatment. For example, the anti-inflammatory medication Tramadol is not universally known as a danger to those in recovery. Tramadol is in a class of medications called opiate agonists, and only a few states classify it as a narcotic. Still, it is often dispensed in ERs and it can trigger a relapse.

You and your dentist might not notice that the mouthwash used routinely in the dentist’s office contains alcohol. Double-check the ingredients in mouthwash and all over-the-counter meds, and make sure your medical and dental charts are marked to indicate that you can’t have alcohol or other addictive medications.

We’ve designed our treatment program to help our residents understand and avoid relapse so they can join 23 million Americans in long-term recovery. Here’s to their health – and yours.

John Perry, Co-Founder, Clean & Sober Recovery Services, Inc.

The Professional’s Perspective: Who relapses, and why?

Photo of Ricki TownsendThe Professional’s Perspective is a guest post from Ricki Townsend, a Registered Interventionist, Drug/Alcohol Counselor, Ncac1, CADC-CAS, Bri-1, Chaplain and Grief Recovery Specialist

Relapse is often described as a part of alcoholism and addiction, but relapse isn’t inevitable. Still, people often worry about the possibility that their loved ones will slip back into drug or alcohol use. And while you cannot control your loved one’s decision to use drugs or alcohol, you can control your own tendency to fall back into “the bad old days” of worry, enabling and co-dependency.

A critical first step in your relapse prevention is to learn about enabling so that you don’t fall into the trap of “If they are happy and safe, then I will be happy and safe.” This is particularly important if you are the parent of a young person in treatment.

It would also be empowering for you to find a good family counselor and learn how to create and keep healthy boundaries. Taking those steps puts you in much better shape to prevent relapse – yours or your loved one’s – or to deal with itconstructively, if it does in fact happen.

My clients who fear the possibility of a loved one’s relapse often wonder about the warning signs. Here are some possible signs that a relapse is “building,” with the first three being the ones I see most often in the first year of recovery:
• Complacency
• Grandiosity
• Not attending Recovery meetings
• Dishonesty
• Hanging with old friends who were users
• Not working with a sponsor
• Making major changes in the first year, such as moving to a new town or starting a new relationship

As we look at our loved ones in recovery, we also need to take a good look at ourselves because family members can relapse, too. The following are the most common symptoms of impending relapse for those of us who deeply love our chemically-dependent children, spouses, parents or siblings:
• Focusing on the loved one to the point that it puts our own health at risk.
• Refusing to believe that our loved ones have a problem with drugs or alcohol (AKA “denial”).
• Covering up the messes – financial or legal problems, for example – and keeping secrets.
• Worrying, feeling constantly stressed and walking on eggshells.
• Having a hard time defining where “they” end and “I” begin.
• Yelling and making empty threats about boundaries that we cannot or will not enforce.

At the end of the day, avoiding relapse requires everyone to change: the person who has substance use disorder and those who love him or her.

Ricki Townsend is a Registered Interventionist, Drug/Alcohol Counselor, Ncac1, CADC-CAS, Bri-1, Chaplain and Grief Recovery Specialist

Building your arsenal for the next drug or alcohol crisis

Most parents with a kid, no matter what age, who struggles with addiction, find themselves constantly investigating, thinking, consulting and planning what to do next. With every relapse or major bump in the road, you stop and take a look at what actions have been taken thus far and what you feel is the next ‘right’ thing to do.

At the beginning of the journey of my teen’s struggle with substance abuse I did not have the resources, so I discussed these things with friends and family. They had not experienced this situation with their own kids, so they had difficulty relating.

Eventually, I had an arsenal of resources: the counselors at the rehabilitation center, Al-Anon Family Support, close friends who also had kids struggling with addiction and various books and articles. I learned that it was important to draw on these resources when decisions needed to be made or when I needed insight to keep perspective on what was happening from time to time.

It is important to build these resources to have on hand.  Many times when we are under duress we do not think too clearly. I remember not being at my best when I was upset and full of fear and worry about what might befall my loved one. I often would get stuck and at a loss for what to do. Once I built my support system – going to weekly Al-Anon meetings for parents, reading daily inspiration from others who had struggled through the same path, and various counselors and professionals – I had a way to get the help I needed when I needed it to do the next ‘right’ thing to help my loved one.

Where should a child live after yet another relapse?

Community coming togetherThese words of wisdom are inspired by Christy Crandall, author of Lost and Found

If your daughter (or son) relapses and asks to come home, it might seems like you are helping her if you say “Yes.” But you may really be enabling her to continue a destructive lifestyle. If she is serious about working a program of recovery, then she will find a sober living center and abide by the rules of that sober community.

While I know this sounds harsh and it is hard to think of your daughter as being possibly homeless, she has to take responsibility for her choices to continue drinking and using drugs. She needs to be more committed to her recovery than you are.

Every county has an access number to get help to those who are suffering from mental illness, substance abuse, homelessness.  Give this number to her, and tell her you will support her as long as she is actively involved in a program. What that support looks like should be up to you, not to her.  If you make it contingent upon her seeking recovery (i.e., going to treatment, living in sober living, etc.) , then you are supporting her in a healthy way.

And consider going to an Al-Anon meeting, specifically one for parents who have kids  struggling with chemical dependency. This will help you make good decisions for yourself and your daughter as you travel on this difficult journey.  Most of all, do not despair. There are 23 million Americans in long-term recovery, and your daughter can be one of them.

Ramping Up for Relapse–Your Child’s or Your Own

Photo of Ricki TownsendRicki Townsend, Family Counselor and Board Certified Interventionist.


Many of my clients fear the idea of their child’s relapse and wonder about the warning signs. Here are some possible “symptoms” of relapse, with the first three being the ones I see most often in the first year of recovery:

  • Complacency
  • Grandiosity
  • Not attending Recovery meetings
  • Dishonesty
  • Hanging with old friends  who were users
  • Not working with a sponsor
  • Making major changes in the first year, such as moving to a new town or starting a new relationship

As we look at our loved ones in recovery, we also need to take a good look at ourselves because family members can relapse, too. The following are the most common symptoms for those of us who deeply love our addicted/alcoholic children:

  • Focusing on the loved to the point that it puts our own health at risk.
  • Refusing to believe that our loved ones have a problem with drugs or alcohol. (also known s denial)
  • Covering up the messes and keeping secrets.
  • Worrying, feeling constantly stressed and walking on eggshells.
  • Having a hard time defining where “they” end and “I” begin.
  • Yelling and making empty threats about boundaries that we cannot or will not enforce.

Relapse is often described as a part of alcoholism and addiction, as if it were inevitable. That is not always the case.  And while you cannot control your child’s relapse, you can control your own. A critical first step in parental relapse prevention is learning about enabling so that you don’t fall into the trap of “If they are happy and safe, then I will be happy and safe.”  Find a good family counselor, learn how to create agreements and keep boundaries, and you will be in much better shape to prevent relapse –yours or your child’s — or deal with it constructively if it does occur.


When the Unthinkable knocks on your front door

Unthinkable things sums up what happens to parents of drug addicts, at least in my world. Take for example, the phone call I got from a police officer of a special fugitive division. He was looking for my son and wanted my help. He knew my name; he knew all my family members’ names. We talked for 30 minutes about the perils my son faces – he’s concerned, he said. The last time he relapsed – pulled over for a traffic violation – he bolted. This “excites” police officers and the conversation turns to the dreaded, unthinkable – the likelihood that my son might do something that causes a police officer to fire his weapon. He might overdose, be killed by another junkie, and a host of other things. My mind already conjures up the worst case scenarios -these events are happening daily in my community. “You could rescue your son,” he threatens with fear. He suggested luring him in with the promise of money; they would wait around corners in undercover gear.

This put me in a strange, but familiar place. It reminded me of a time when I held onto the pseudo-belief that I have a lot of power and control over my son. With my own recovery from the family disease I know better. This is bigger than me and it’s not my business. Besides, there are always more outcomes than he presented – we don’t know. If I did these things, and my son was harmed as a result, would I be able to live with myself? If I didn’t do the sting operation and my son is killed on the street, would I be able to live with myself? Do I really have that much power?

I decided I would encourage my son to get help as I have always done, knowing this is his life and I’m not in control of it. That was if and when I would hear from him – he does not answer my calls either. Today I have a Power, greater than me that will guide me to a sane position. The perils of drug abuse, addiction and the disease related crimes by young people are unthinkable. And they progress. And their family, who love them beyond measure, can not save them with that love.

We all fall down: when the addict and family relapse

Photo of Ricki TownsendThis is a guest post from family counselor and interventionist Ricki Townsend

In the disease of addiction, as in most diseases, there is the chance of relapse. Both the substance abuser and the family must remember that we are only in remission.  Addiction doesn’t disappear; it is a chronic disease that may include relapse.

What does it look like when remission ends and relapse sets in?  Typically, recovery for all family members has been going well.  The family has been going to Al-Anon.  The addict/alcoholic has been going to AA or NA.  An agreement is in place, and everyone has been abiding by its terms. Things have been getter better, one day at a time, for six to nine months. The rough edges are smoothing out.  The beloved addict is now showing up in an honest way, and everyone starts relaxing.

Bit by bit, though, people become complacent.  The addict misses a meeting, or two.  The parents slack off on the drug testing. Other elements of the agreement are overlooked.  All of a sudden, relapse barges through the front door.

Old behaviors return in full force.  The addict starts using or drinking again, the parents resort to their earlier behaviors, whether enabling or withdrawing from the chaos.  The entire family is in relapse.

This scenario brings heartbreak, anger, stress, and panic.  What do you do now that it’s all falling apart again? How do you get back on track? This is a time to call an addiction professional that you trust and ask them to listen to you, your fears, and your pain.  Then listen to their ideas, which will be much more objective than yours. Is your loved one heading the right direction after relapse?  Going to meetings?  Testing clean?  Humble?  Scared?  Did you stick with your agreement?  What do you need to do differently this time around?  The answers to those questions will guide you as you think about the steps you need to take. Perhaps you will want to invite the professional to mediate between you and your loved one to reset the rules.

Because your family is a “system” with interlocking parts, you need to look at your role in the relapse.  Are you heading the right direction after the relapse? I invite you to breathe, spend some time alone to regain your balance, and consider your next steps. You can’t change the addict, but you can change yourself.  What might you do differently this time around?

There is no one “right” answer for everyone.  You need to find the answer that works for you and your family; the only “must” is that you seek that answer thoughtfully, constructively and respectfully.


Ricki Townsend
Board Certified Interventionist, Drug/Alcohol Counselor
NAADAC Certification Commissioner
Ncac1, CAS, RAS, Bri-

Is Suboxone a solution or simply another addiction?

What role can Suboxone play in recovery from opioids?  It’s a controversial subject. Here is the perspective of Mel Pohl, M.D., Medical Director, Las Vegas Recovery Center
Because relapse rates with opioid addiction are so high, many clients and treatment professionals have turned to medication assisted treatment (formerly called maintenance) programs that provide long-lasting opioids such as methadone (Dolophine) or buprenorphine (Suboxone and Subutex).  I am not a fan of buprenorphine for maintenance for the reasons stated below, but there are many addiction specialists who believe that it is the best available treatment for opioid dependence. I am not among them.

Buprenorphine’s unique pharmacology causes less of the same negative side effects commonly seen with morphine and methadone (e.g., respiratory depression, cognitive impairment, and euphoria more likely to be associated with craving and abuse) and has opened the way for treatment of opioid dependence in new settings. This allows treatment options to reach those who may not have previously had access or don’t feel comfortable with other treatment settings such as a methadone clinic. Buprenorphine has been touted as a safe, low risk option for treatment of opioid dependence because of its mild effects and a ceiling effect at high doses. Yet, despite the apparent advantages of buprenorphine over other opioid maintenance medications, an abuse potential remains.

Here are several key questions to consider regarding the use of buprenorphine for the treatment of opioid addiction:

  • Is the brain of the opioid addict more normal with buprenorphine than without, as many medication assistance proponents assert? At least with methadone dependent addicts, it has been shown that
    brain dopamine transport system is impaired compared to abstinent opioid addicts.
  • Is there a reasonable hope of achieving a buprenorphine-free state once it has been started? If so, when is the logical time to attempt withdrawal? After six weeks, six months, two years? If withdrawal fails, is that because of dependence on buprenorphine, which is extremely difficult to discontinue, or is relapse inevitable in the absence of some opioids? We all know that discontinuing maintenance doses of opioids is extremely difficult; but is that because of withdrawal (protracted with buprenorphine) or is it because the brain requires a medication like buprenorphine to function and feel normal.
  •  There are clinics that have sprung up in some cities that include buprenorphine treatment among a vast “service line” menu, including Botox, Restalyne, liposuction, and teeth whitening. Do we truly expect an addict to find recovery in such a setting?
  • How are you to manage these clients as an addiction professional? It is your task to help clients find quality in their lives.  Can you steer them to buprenorphine-friendly meetings? Should the      maintained addict go to mainstream meetings and hide the fact that they are on buprenorphine. It is not uncommon for addicts who disclose their status to be ostracized or encouraged to discontinue medications by nonprofessional peers. Can you help clients navigate these difficult waters and develop a supportive community to help them as they live life on life’s terms?
  • Some feel that opioid-free is simply not an achievable state; the data appears to suggest low percentages of successful abstinence. Where are all the addicts who are successful? There are     thousands of opioid addicts in recovery who have abstained through the help of the twelve-step fellowships for decades. We know it can be done, but how can we tell who is likely to be successful?
  • Do we commit everyone to maintenance for life? Is this “harm reduction” or are we actually doing harm by using medications for all without attempting to help clients achieve a drug-free state? Do we try abstinence a time or two or ten? Do we eventually accept buprenorphine-maintained recovery as a reasonable alternative? Do we try again for abstinence after a time?  If so, when? -Mel Pohl, M.D., Medical Director, Las Vegas Recovery Center