Reasons Why Drug and Alcohol Rehab Success Rates Are So LowStudies show that roughly 40 to 60 percent of people recovering from drug or alcohol problems will relapse at least once after entering or completing treatment. While this figure may seem extreme, it actually falls in line with expectations for anyone coping with a chronic illness. A variety of factors contribute to the risk of relapse occurrence. However, not all people are exposed to the same individual factors.

Addiction Relapse vs. Other Forms of Relapse

Chronic disease relapses occur when people affected by a long-term mental or physical health condition return to behaviors that cause their health to worsen over time. Substance-related issues are probably the best-known examples of this type of situation. However, public health experts don’t view relapses related to substance addiction — which is a form of chronic brain illness — as fundamentally different from relapses related to other long-term health issues such as asthma, high blood pressure and type I diabetes[i].

The Journal of the American Medical Association and the National Institute on Drug Abuse report that the relapse rate for substance problems is comparable to the rates associated with other chronic diseases that have a life-threatening potential. For example, roughly 50 percent to 70 percent of all people with asthma or high blood pressure will at least temporarily stop taking the steps required to safeguard their health. The same holds true for roughly 30 percent to 50 percent of all people with type I diabetes.

Stress and Exposure to Substance Use Triggers

Stress is known as one of the potential reasons why people from all walks of life develop drug and alcohol problems. Substance use disorder treatment programs commonly teach clients ways of dealing with their unhealthy stress reactions. Nevertheless, exposure to high-pressure situations can still trigger a relapse in any person who has enrolled in treatment or completed treatment[ii]. Doctors can estimate the degree of risk by tracking the body’s levels of key stress hormones.

Numerous studies have shown that people who drink or take drugs learn to associate their behaviors with specific places, people and events. When exposed to these factors, their desire for substance intake can rise significantly. As with stress exposure, treatment programs help participants learn how to cope with their particular environmental triggers. However, these triggers don’t just fade away. Any person who returns to an environment associated with past substance use/abuse may experience an increase in short-term relapse risks.

The Presence of a Co-Occurring Disorder

Co-occurring disorder is the term used to describe overlapping symptoms of substance use problems and a mental health problem. Experts once used the term dual diagnosis to describe the same overlapping conditions. A co-occurring disorder can involve any form of drug or alcohol problem, including the use of multiple drugs or the combined use of drugs and alcohol. It can also involve any form of mental illness. Some of the most likely convergences of substance issues and separate mental health issues are:

  • Alcoholism associated with panic disorder (i.e., repeated panic attacks)
  • Cocaine addiction associated with major depressive illness
  • Multiple drug consumption associated with borderline personality disorder

The real-world impact of a co-occurring disorder can vary by a considerable degree. However, compared to people only coping with addiction or only coping with a separate mental illness, people coping with overlapping problems have an overall greater chance of experiencing a range of setbacks before, during and after treatment. High on the list of potential setbacks is an increased likelihood of relapsing back into excessive drug or alcohol intake[iii].

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A Personal History of Childhood Maltreatment

Childhood maltreatment is an umbrella term that applies to any form of physical abuse, sexual abuse or neglect that occurs in a person age 17 or younger. The problem is widespread, for example, the World Health Organization reports that roughly 25 percent of all adults have a personal history of childhood physical abuse[iv]. In addition, roughly 20 percent of all women and 8 percent of all men have a childhood history of sexual abuse.

In a study published in 2014 in the journal JAMA Psychiatry, a team of researchers looked at the connection between substance relapse risks and damaging brain changes linked to exposure to childhood maltreatment. These researchers found that specific brain alterations associated with child abuse and neglect make it more likely that affected adults will relapse after receiving treatment for drug or alcohol problems[v]. They also recommended that all substance programs take histories of childhood maltreatment into account when devising treatment plans.

A range of treatment-related factors can also increase the odds that program participants or graduates will experience a relapse. For instance, people affected by a co-occurring disorder may end up in programs that don’t adequately deal with the substance side of their overall health picture. In some cases, treatment centers may inadvertently increase relapse risks by failing to complete thorough clinical or cultural assessments for all participants. As a rule, the odds of returning to active substance use also go up when a substance program employs under qualified staff or fails to address the psychological and behavioral aspects of addiction.

Lack of Sufficient Continuing Care

Research shows that enrollment in continuing care after treatment is an important step in the maintenance of ongoing sobriety[vi]. Continuing care programs function in the same basic way as primary substance treatment programs. However, they require a lower level of involvement. The specific degree of involvement varies according to the type of primary substance program. For example, a person who graduates from a partial hospitalization (PHP) program may follow-up by enrolling in an intensive outpatient (IOP) program. In contrast, a person who began treatment in an intensive outpatient program may follow-up by enrolling in a standard outpatient (OP) program.

People who take part in appropriate continuing care programs typically reduce their odds of relapsing by a significant amount. Benefits are greatest when enrollment lasts from half a year to a full 365 days. Follow-up treatment also has a bigger impact when it is flexible and adjusts to the changing needs of each participant.

Transformations Treatment Center offers individualized treatment plans to all clients including our PHP, IOP, OP and IOP with medication-assisted treatment program. Clients in the IOP MAT program participate in groups therapy sessions, three times per week, and regular medication management appointments.

  1. National Institute on Drug Abuse: Principles of Drug Addiction Treatment – A Research-Based Guide (Third Edition): How Effective Is Drug Addiction Treatment?
    https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-effective-drug-addiction-treatment
  2. University of Illinois at Chicago: Relationship Between Stress and Substance Use Disorders – Neurobiologic Interface
    http://www.cmhsrp.uic.edu/download/Brady_2-15_Presentation.pdf
  3. Psychology Today: Co-Occurring Disorders
    https://www.psychologytoday.com/us/conditions/co-occurring-disorders
  4. World Health Organization: Child Maltreatment
    http://www.who.int/mediacentre/factsheets/fs150/en/
  5. JAMA Psychiatry: Childhood Maltreatment, Altered Limbic Neurobiology, and Substance Use Relapse Severity via Trauma-Specific Reductions in Limbic Gray Matter Volume
    https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1878918?resultClick=1
  6. Psychiatry Journal: The Continuing Care Model of Substance Treatment- What Works and When Is “Enough,” “Enough?”
    https://www.hindawi.com/journals/psychiatry/2014/692423/
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