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It’s not what you want to hear, but it is something you need to hear nonetheless. If you’re about to send your partner into a treatment program for his pain killer addiction, for example, this probably won’t be the last time you have this experience—not if the two of you remain together, that is. As sad as it is, only about twenty percent of the people who go through an alcohol or drug addiction treatment program will still be off the chemical substance a year later.

Why is relapse such a problem for those suffering from alcoholism and drug addiction? This is something we’re still struggling to understand.

Sometimes the Cravings Never Die

We know that addicts often suffer cravings for their drug of choice long after abstinence is gained. Some people hunger for the substance even years later. Scientists suspect this might be due to changes that occur in the brain as a result of the use of the chemical substance. The brain gets used to functioning with the drug, and it seems to lose its ability to do so without that chemical substance.

We also suspect that cravings are aroused by cues that the addict will encounter despite a drug-free life. These could be people, places, and things that are all associated with the former lifestyle. In fact, we now know from brain scans that, even if the brain is exposed to an image for such a short time that a normal brain would typically not react to the image, the brain of the recovering addict is activated. In other words, the addict’s brain lights up in places and ways the brain of someone without an addiction history simply will not. As a result, we can assume the addict’s brain is remembering those highs and hence, the person feels the urge to use once again.

Conversations with recovering addicts basically confirm this, too. Some of the honest ones will tell you that when they see images of themselves using drugs during their times of heavy usage, for instance, they can not watch these without remembering how great the high or the rush was. So, while those of us who do not have addiction histories might be disgusted by such images, their brains respond to the pleasure, not all of the pain that addiction invariably brings.

Recovering Addicts Must Change Playpens and Playmates

This is why programs such as Alcoholics Anonymous (AA) they tell people that they must totally change their playpens and play mates. To do otherwise, the alcoholic or addict is told, is to ask for immediate relapse.

It can help the recovering alcoholic or drug addict to be with others in support groups such as AA. Of course, it’s important that attendees don’t talk about the glory days of drug use but instead, remind themselves of all the pain or the hell they ultimately went through because of the alcoholism or addiction. And invariably, they will have such storied to tell. Most addicts who seek out help via AA or treatment programs have “hit bottom”—or at least come close enough to it that they realize that the alcohol or drugs turned on them. While initially the substance may have provided a great high, the time comes in an addict’s life when the substance ceases to provide the high it once did. The emotional pain of the lifestyle often is more painful than the pain the addict may have been experiencing initially—the emotional pain that causes the individual to turn to drugs in the first place.

Physiologic Response Associated with Drug of Choice

The addict doesn’t appear to respond to all cues related to drugs or alcohol, but to those associated with the drug of choice. For example, when a cocaine addict observes environmental cues related to cocaine use, anticipatory reactions are triggered in the person. What are these? Well, examples include heart rate, blood pressure, and pupil size. That said, the cocaine addict will not respond in these same ways to cues applicable to heroin use.

It’s important to realize that most addicts don’t relapse merely because they’ve been exposed to such images. Rather, they are inclined to begin using the drug of choice again when in a negative mood state.

Still, it’s not like the addict just feels down one afternoon and takes up using again, either. Normally, something has happened that the person finds difficult to cope with—such as the death of a loved one, the loss of a job, or there are economic problems. It takes more than seeing someone else get high, or connecting with a former buddy from the using days, for the sober addict to relapse, in other words.

The problem with a relapse, however, is that it is usually a quick downhill slide. It is almost as if the person is bound and determined to make up for lost time. So, while it might have taken the person years to get to a certain level of use of the substance, very soon the person is back using at that same level as when he or she entered treatment. And indeed, sometimes it can seem that this level is reached almost immediately.

Addict Must Take Immediate Responsibility for Relapse

It’s important for the relapsed addict to do something about the relapse immediately—to try and avoid the above-mentioned scenario. If such quick action is taken, the addict will experience what might seem more like a stumble versus being sucked into a black hole—out of which the addict may sense he’ll never return. Of course, it is important for the addict to try and understand why the relapse likely occurred. This can help the addict come up with an action plan to try and keep him out of trouble—or to nip it in the bud if he is tempted to use. For example, he could develop a plan for staying out of high risk situations; a plan or techniques for dealing better with stressful situations that are likely to arise; and self-talk that he can use to fight urges he may feel—that threaten to get the best of him.

Of course, it would be great if you could help your partner to develop such strategies. But if your partner is a narcissist, this may not work as well as you would hope. You may find yourself being blamed for the stress that threw him back into the addiction, for example. So, be certain that you don’t accept any blame and shame he tries to place on you. Be prepared that he might make it impossible for you to be a supportive and helpful partner—so that he can continue to play the blame game and shirk responsibility.

If you find yourself in this latter situation, ask yourself, “Do I want to be around for the relapses that will inevitably follow?”

In my case, I decided that I did not. You’ll have to make your own decision.