Heroin Relapse: Prevention

Relapses can be triggered by personal experiences, social environments, and life events, often in combination with one another.

This could include:

• Experiencing intense physiological cravings for heroin
• Undergoing unexpected or overwhelming stress
• Experiencing trauma, loss, or grief
• Re-engaging with people you used to use heroin with
• Certain sights or smells
• Intentionally or accidentally attending an event where people are abusing heroin
• Suffering from an undiagnosed or improperly treated co-occurring mental health disorder (e.g. anxiety disorders, depressive disorders, PTSD)
• Overconfidence
• Loss of self-esteem
• Lack of education on physical dependency
• Boredom

Many people believe that relapse simply describes the final act of retaking a drug after a period of deliberate sobriety.

When you think of it this way, you can misunderstand relapse prevention as simply learning to say no, or stopping yourself just before using; however, relapse can be divided into three stages. Prevention is an involved process that occurs before and during each stage.

1. Emotional Relapse:

This is the first stage and is characterized by the unhealthy handling of emotions related to drug use. When someone is going through an emotional relapse, they will often deny their true feelings of struggling with heroin addiction. Look for these signs:

• Suppressing your emotions
• Isolating from friends and family
• Failing to attend support group meetings
• Attending support group meetings but not sharing experiences
• Over-focusing on other people, their problems, or how they affect you
• Not eating or sleeping well

The most common characteristic we see in emotional relapse is people not keeping up with self-care. This can either be physical habits (i.e. eating, sleeping, personal hygiene) or emotional ones (i.e. being kind to yourself, having fun, connecting with others).

2. Mental Relapse

Mental relapse is the stage when thoughts about drug use fully resurface. This stage is characterized as a battle between two sides of a person. Part of you will want to use heroin, and part of you will be fighting back. This is not the same as the brief, occasional thoughts about using the drug that occurs throughout recovery and are positively overcome. This voice is constantly debating and seems to have a justification for everything. As you circle deep into mental relapse, the healthy voice loses its strength.

Watch out for:

• Strong cravings
• Mulling over thoughts about people, places, items you saw when you used before
• Minimizing the harm that past heroin use caused you
• Bargaining “Just one time, just with this one person…”
• Lying to yourself or others
• Trying to work out ways to use again but with better control
• Planning how, where, or when you can use heroin

3. Physical Relapse

The final stage is the physical act of reintroducing the drug to your body and is the most difficult stage to stop.

Physical relapse is most likely to happen in a situation or a window of time when it feels like you will not get caught. It is also often tied up with moments of overconfidence about the consequences of relapse or moments when self-esteem has drastically fallen, and you might feel like you cannot keep up the efforts of sobriety. Remember, factors like stress and depression can often trigger heroin abuse.

Heroin relapse is fraught with immediate physical and psychological effects. Physical relapse can swiftly bring back physical dependency. Returning to the drug even once is likely to set in motion even more obsessive thoughts about using, keeping mental relapse viciously in effect.

Relapse prevention should be an everyday practice.

If it is approached as a set of habits that are set aside after leaving treatment for “when they’re needed” again, they are unlikely to work. The coping skills you learn as part of a long-term drug rehabilitation program are there to help you build resistance to each stage of relapse. If you become concerned that you are moving towards a potential relapse, it is paramount that you reach out for help as early as possible before finding yourself on the brink of using again.

Cognitive Therapy

Cognitive therapy is a cornerstone of our heroin rehabilitation program at Cirque Lodge. It is an excellent tool for developing resilience against relapse-inducing thoughts and behaviors. It can also help in treating co-occurring mood disorders that feed into heroin addiction and cravings. This therapy highlights people’s negative thinking patterns and helps them transform them into healthy coping skills. Negative thinking can feed into addictive thinking in various ways, including:

• Negative self-labeling, undermining self-esteem and confidence
• Fear of recovery
• Catastrophizing challenges to recovery
• Minimizing successes, ignoring all the healing that has occurred
• Recovery is all-or-nothing, and any setbacks are viewed as a total failure

If you do not learn and practice coping skills, these negative thoughts feed into each stage of relapse, pushing it forward.

Support Groups

Finding a community of mutual support and genuinely engaging with it is another vital part of long-term recovery success. The choice to join a recovery group is to hold yourself accountable and vulnerable to people who are walking the same path and understand what you are going through.

The process of listening to others and sharing your experience with a group of people who understand the recovery process is integral. It can help you internalize the idea that setbacks occur, but they are always possible to overcome. Support groups give you space to check in with how you are feeling and to practice and share the skills you have learned.

At Cirque Lodge, part of our heroin rehabilitation program involves helping you build a list of support groups in your area that suit your needs. We also have several alumni groups and sober buddy programs that serve similar purposes. If you allow yourself to become isolated, it is all too easy to sink into negative thinking patterns.

Family

Early relapses are often brought on by returning to the same environment that you left. When the family of a person in recovery is not well informed about both addiction and prevention, relapses occur. Often they can unknowingly create triggers that make their loved one crave heroin again. When this is happening at home, sobriety becomes very difficult to sustain.

At Cirque Lodge, we are commended for our family program – it is an intrinsic part of our approach to recovery. This takes the form of weekly therapy sessions you attend as a family unit. These sessions can be groundbreaking in helping to heal the damage heroin use can cause and in helping your loved ones to understand addiction. This safe space allows families to get to the bottom of the thoughts and situations that can trigger heroin relapse, and the skills learned, and knowledge gained supports the family as they move forward together.

Family Week also takes place for four days every three weeks. Here, we invite families to come to the center and participate in a variety of educational workshops and lectures, group therapy, and experiential workshops. We strongly encourage family members or partners to attend this week, as behaviors at home tend to have very positive or negative effects on the success of recovery after rehabilitation.