The Progressive Worsening of Relapse and Detox
Relapse is a common part of the path to lifelong recovery from substance abuse, addiction and alcoholism. In fact, relapse is so common that very few people get clean and stay clean for life on the first attempt. Much like cancer going into and coming out of remission, the disease of addiction often resurfaces for many people. Understanding this phenomenon is important because in many cases each progressive relapse is worse than the last, and the detox, withdrawal and clean-up process can get more difficult with each successive recurrence. This also means that for some, each relapse could bring them closer to catastrophe.
Detox is one of the first things that a person will go through when they decide to stop using drugs or alcohol. In most cases detox occurs in a specialized medical facility that is equipped to handle the unpleasant and sometimes dangerous symptoms of Acute Withdrawal Syndrome. This syndrome is caused by the natural processes of the body purging itself of a substance and returning to a state of normalcy. This process can make some people quite uncomfortable, and many recovering addicts report that each period of withdrawal is far worse than the last.
According to the American Academy of Family Physicians, this is known as the Kindling Effect;
An important concept in both alcohol craving and alcohol withdrawal is the “kindling” phenomenon; the term refers to long-term changes that occur in neurons after repeated detoxifications. Recurrent detoxifications are postulated to increase obsessive thoughts or alcohol craving. Kindling explains the observation that subsequent episodes of alcohol withdrawal tend to progressively worsen. (1)
One troubling aspect of the kindling phenomenon is that addicts often become aware of this issue, which then causes them to have more difficulty getting sober with each successive withdrawal. Unfortunately, all of these problems also hold true for relapses.
Relapses are generally caused by Denial or Post Acute Withdrawal Syndrome symptoms. Like detox and withdrawal, each relapse is theorized to be worse than the last. This may include the severity of the drug or alcohol use as well as the duration of the relapse period. In reality this means that successive breaks from sobriety can make both the next withdrawal and the next relapse considerably worse.
However, most people who have been affected by addiction agree that relapse is often part of the learning process. And while each withdrawal and relapse might be worse, it also becomes easier to understand, more predictable, and the healing process can often be directed by an experienced patient without starting over as a “first-time addict.” In fact, many people who relapse report that they had short “slips” – meaning they used drugs or alcohol again, but only very briefly and quickly worked to get sober again. But the National Institute on Alcohol Abuse and Alcoholism stresses the effects of repeated relapses:
Finally, experience with repeated cycles of chronic alcohol exposure and withdrawal not only led to an exacerbation of the physiological symptoms of withdrawal but also to enhanced susceptibility to relapse (for more information on this issue, see the sidebar, “Repeated Alcohol Withdrawals: Sensitization and Implications for Relapse”). Thus, a growing body of evidence indicates that alcohol dependence and withdrawal experiences significantly contribute to enhanced relapse vulnerability as well as favor sustained high levels of alcohol drinking once a “slip” occurs. (2)
The fact of the matter is that addiction, detox and relapse affect everyone differently, and there are no set rules. However, there is one rule that should concern anyone with a drinking or drug problem: getting help immediately.
(1) Max Bayard, M.D., Jonah Mcintyre, M.D., Keith R. Hill, M.D., and Jack Woodside, Jr., M.D. Alcohol Withdrawal Syndrome East Tennessee State University, James H. Quillen College of Medicine, Johnson City, Tennessee Am Fam Physician. 2004 Mar 15;69(6):1443-1450.
(2) Becker, Howard C. PhD. Alcohol Dependence, Withdrawal, and Relapse National Institute on Alcohol Abuse and Alcoholism