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Help for the chronic relapser

October 5, 2011
by Heidi Voet Smith, LPC
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Success in treatment requires time and a high degree of accountability

Treatment providers, family members and the general public often are baffled when individuals who have received good addiction treatment continue to relapse. As the clinical director at Burning Tree Recovery Ranch in Texas, I serve only clients with a history of chronic relapse. Through my experience working with this population, I have discovered that this type of addict is not as mysterious and complex as many might think. In fact, the chronic relapser is quite predictable-and treatable.

Through this work, I have come to develop an intimate knowledge of the defining features in the profile of chronic relapsers.

Profile of the chronic relapse

Heidi voet smith, lpc
Heidi Voet Smith, LPC

Numerous failed attempts at sobriety, or a return to drugs/alcohol after a substantial period of sobriety. While this is a simple and obvious criterion of a chronic relapser, the distinction of an individual who has attempted sobriety and failed is important. Many addicts have a lifetimeof drug and alcohol abuse but have never actually attempted to get sober. What makes chronic relapsers distinct is that they have tried and failed.

Unable to maintain sobriety despite having a wealth of knowledge about addiction and recovery. Often, chronic relapsers know enough about the disease concept, the 12 Steps, relapse triggers, the neurological impact of drugs, and family roles to teach classes on substance abuse at a treatment center. However, they have no experience in applying this knowledge to their lives in a way that creates lasting sobriety. Their wealth of knowledge is something that chronic relapsers will often use as a weapon when loved ones attempt to intervene.

Continued substance use despite significant, severe and repeated consequences. This is the baffling and insane feature of addiction in general, but particularly with chronic relapsers. Despite loss of children, loss of family, homelessness, seizures, heart attacks, diseases, prostitution, incarceration and overdose, chronic relapsers continue to drink and use drugs. While they may have an intense and honest desire to stop using, they are powerless to make that choice.

Chronic relapsers often feel hopeless that they will ever find lasting sobriety. Addicts in their first attempt at sobriety, whether in treatment or a 12-Step program, often possess great hope and excitement about a new life. With chronic relapsers, however, there is frequently an intense hopelessness and a cynical outlook on any possibility of permanent sobriety. Upon arrival at Burning Tree Recovery Ranch, clients often tell me they are here just so that when they die of this disease their family will know they tried everything and will have peace. Based on their life history, chronic relapsers are convinced they are beyond repair.

Multiple treatment episodes, including psychiatric treatment, detox, residential, outpatient, and halfway houses. This often includes relapse just hours, days or weeks after getting out of treatment. Chronic relapsers also have a significant history of using in treatment, getting kicked out of treatment, and leaving treatment early.

Significant exposure, attendance and/or participation in 12-Step programs. Chronic relapsers have a history of repeatedly working Steps 1, 2 and 3, but have never completed all 12. They have picked up numerous “desire chips.” They have attended countless meetings. They even may have had sponsors. Unfortunately, they many times have just enough experience with the 12-Step fellowship to think they know it won't work for them. However, the majority of chronic relapsers have never had a deep and meaningful experience through working all of the Steps in the way they are intended.

Treatment savvy-have learned to navigate their way through the treatment industry to meet their own agenda. Chronic relapsers often know how to get around treatment center rules and to play the treatment center game. They have been in and out of institutions and can easily figure out what they need to do to graduate successfully and appease others. Chronic relapsers also have a gift for splitting staff, influencing peers and becoming a virus in a treatment community. Many times they have mastered the art of working the therapists. They have learned to feign trauma, trump therapeutic issues and play up their dual diagnosis symptoms.

A unique talent to exhaust the financial resources and emotional support of loved ones. Chronic relapsers leave their loved ones depleted of energy and emotional resources. They are often lovable and convincing, which enhances their amazing ability to get their family members and others to continue giving of their resources.

As with most addicts, a pervasive cluster of personality characteristics are frequently exaggerated in the chronic relapser. We have found that they are very charming, intelligent, manipulative, convincing, deceitful, lovable, talented and passionate. These personality traits often are what helped them survive through years of dangerous drug and alcohol abuse and all that comes with that lifestyle. Chronic relapsers have mastered the art of survival, in and out of treatment.

Axis II personality disorders or personality traits. Chronic relapsers are many times diagnosed with or display significant symptoms of Axis II personality disorders, especially borderline personality disorder, anti-social personality disorder and narcissistic personality disorder.