December 12, 2011

Recognizing the signs of a loved one’s relapse

By Stacia Nash
Your daughter acts unusually aloof, even for a teenager. Your husband works late and can’t take your phone calls. Legit behaviors? Perhaps. But for those of us living with a loved one in recovery, these may be red flags for a relapse.
As we’ve covered in our ongoing series on relapse, the process begins way before someone picks up that first drink or swallows that first pill. Whether it happens five days after checking out of rehab or 20 years down the road, relapse is a process of changing behaviors and shifting attitudes that, if left unchecked, may lead back to abuse.
No matter the time frame, relapse develops in stages, says Cheryl Knepper, executive director of adult and family services for Caron Treatment Centers. Typically, describes Knepper, the addict:
  • Commits to stabilize and receive  treatment
  • Undergoes counseling
  • Believes “I’m cured”
  • Stops going to meetings
  • Returns to old patterns
  • Has a stressor and returns to old behavior;-Starts to isolate
  • Returns to the old people, places and things
  • Feels pain
  • Craves addiction
  • Finds his or herself in a high-risk situation
  • Starts using again
If you’re going to stay the course and work toward a strong recovery with your loved one, you need to engage in the recovery process. “I think a lot of people forget that addiction is a family disease,” Knepper says. “Everyone plays a role: the enabler, the hero, the scapegoat, the benefactor, the one that bails you out. You are powerless over the disease, but you have control over your life. Often people think intervention is the answer or treatment is the answer. But the family needs to be actively engaged. That’s how it really works.”
As hard as it may be to confront your loved one about their denial, ignoring a possible relapse only enables the process. “A lot of fear stops family members from dealing with denial,” Knepper says. “You need to gain knowledge. The more education you can get about the disease and your role as a loved one, the better you are going to be in helping a loved one get treatment.”
Sierra Tucson family therapist Mike Graziano agrees. “Family members need to get healthy and have support, find strength for themselves,” he says. “That’s the most important thing.” Family members often feel shame or fear and wonder if they caused the addiction. Feelings like these need to be shared with other people who can relate, understand and provide guidance. By reaching out to family, friends, individual counselors or any number of support groups, families will get healthier.
In addition to finding support from others, you need to take a hard look at yourself and determine what you’re willing to live with, what you’re willing to let go of and what you’re willing to do to provide the best life for your family. If you sense that a loved one is in denial, you need to address your concern confident that you’re doing what’s best for everyone.
“It isn’t because the patient needs help,” Graziano says. “It’s because the family can’t continue to rescue, fix and rescue. The desire is to rescue. They play the victim. You can’t rescue them from themselves. We can’t be recovery cops.” 
When approaching a loved one in denial about relapse, “The key is not to blame the addict,” Graziano says. “They will shut down.” Graziano and Knepper recommend taking the following steps when addressing your concerns with an addict:
  • Do not address the addict when they are active in their addiction.
  • Talk about what’s going on with you, how you are feeling and what you are concerned about so that the addict understands the impact on your relationship.
  • Do your best to explain how the loved one’s actions are impacting you and your family (e.g., absence from home, financial hardships), but do not attack.
  • Ask the addict to help you understand what he or she is feeling.
  • Offer to give rides to meetings and schedule appointments, anything to show your commitment to recovery.
  • Discuss the addict's personal triggers and create a plan to ward off potential crisis situations.
  • Set boundaries, define the consequences and always follow through.
Remember, you want to support recovery—not the addiction. Graziano points out that most families in a state of crisis don’t realize that their desire to help is unproductive. “In situations with a vicious cycle, it becomes an instinct,” he says.
“You reach a point of fear and are afraid of what will happen if you do anything different. You get stuck in the fear. It’s familiar; it’s comfortable. And you know how to deal with it that way. But you have to get beyond the fear. If you can remove the fear, then you can move forward.”
In short, you need to break the cycle. Whether this means taking your loved one to dinner and a meeting on Friday night or driving to weekly support groups before soccer practice, you need to change the way you deal with addiction. Most importantly, you need to constantly remind yourself that you didn’t cause your loved one’s addiction—nor can you cure it or control it. “People think they are powerless,” Knepper says. “Don’t give up. All you can do is control what you do. This is a disease that many people can live with.
Sometimes when our loved ones hear what we’re saying, they want to see you make a change as well. That’s why it’s important to break a cycle and get support for you. It shows that you’re invested in this process.” 
Dealing with a loved one in denial is tough love, for sure. They may get angry. They may blame you. They may say you didn’t do enough. But you need to remember that no one will get better if you continue to make peace instead of make change. “You have to change the script,” Knepper says. “You have to detach with love, and let your loved one know that your messages to them are going to change.” 
At the end of each day, remind yourself that addiction is a family disease and recovery is a process. And with that, it’s as important for you to take care of yourself and your family as it is to support your loved one through recovery. “There is hope,” affirms Graziano. “Through recovery of individuals, we can find love.” 
Stacia Nash has more than 10 years of experience writing for lifestyle, healthcare and entertainment publications. She earned her master’s degree in journalism from the Medill School of Journalism at Northwestern and continues to cheer on the Wildcats with her three young sons.



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