By Meghan Vivo

When a person goes back to using drugs or alcohol after working hard to get clean and sober, it can be mystifying and heartbreaking to the people around them. How did the recovering addict miss the warning signs?  

Understanding Relapse

Relapse is a process, not an event. There are warning signs that appear long before a person actually takes a drink or uses a drug. If the person takes action early on, they can avoid a full-blown relapse, but if they ignore the early signs, their chances of staying drug-free are slim.

“The first steps toward relapse have nothing to do with drugs,” explained Ryan Anderson, Ph.D., a clinical field therapist at Outback Therapeutic Expeditions wilderness therapy program for troubled teens. “Relapse most often begins with a breakdown in coping skills or relationships.”

Once a person becomes addicted to drugs or alcohol, drug cravings and triggers to use are inevitable. Because addiction is a chronic, progressive illness, relapse is common. That’s why a relapse prevention plan is an essential part of recovery.

In wilderness therapy, teens learn how to identify the early stages of relapse and develop a relapse prevention plan so they can take action before they fall back into old patterns.

Dr. Anderson shared the story of one student who took advantage of his parents’ visit to Outback to try to convince them to bring him home. He repeatedly promised he wouldn’t relapse and was ready to go home, yet when a thunderstorm came, he was so busy pleading his case that he refused to work with his parents to put up a shelter and make a fire.

Although he was confident he wouldn’t relapse, he was relapsing right before his parents’ eyes, noted Dr. Anderson.

“He wasn’t abusing drugs, but the way he coped with difficult situations showed his vulnerability,” Dr. Anderson said.

Relapse Prevention Tools in Wilderness Therapy

Outback utilizes wilderness therapy to provide teens with the tools to prevent relapse. The therapists and field instructors help students identify potential issues while they are in a safe, drug-free environment. In the wilderness, there is no access to drugs or alcohol and students have plenty of peer support to cope with difficult emotions and learn new skills.

“Lots of things can be steps toward relapse,” said Dr. Anderson. “Talking romantically about past drug use, avoiding difficult situations like an emotionally charged group discussion, shutting down and refusing to talk through an issue – all of these can be signs that old habits are resurfacing.”

At Outback, opportunities to develop relapse prevention skills commonly present themselves in the areas of food trading, war stories and ritual.

The Hidden Dangers of Food Trading

One of the rules at Outback’s wilderness camp is that students are prohibited from sharing food. At first glance, trading food with another student may seem insignificant. What could be the harm? In addition to being potentially unsafe, said Dr. Anderson, trading food can be a sign of impulse control issues or an inability to resist temptation.

“To get another student’s food, there has to be some degree of dishonesty or deception,” said Dr. Anderson. “Both of these are common precursors to relapse and signs that the student hasn’t learned some important lessons. Something as small as trading food can point to the bigger reasons the student is at Outback.”

Interestingly, the foods that are most often traded are sweets, which are known to trigger the same type of dopamine response in the brain that drugs trigger. These types of temptations are a natural part of wilderness therapy and can’t be easily imitated in more conventional treatment settings. The goal of wilderness therapists and field staff is to take advantage of those opportunities to teach students valuable life lessons.

If a student tells Dr. Anderson that they’re confident that they’ll be able to stay drug-free in the future, but they’re still trading food, he knows the student hasn’t quite found their way yet. While food is the temptation at wilderness camp, many other temptations will arise when the student returns home.

Food sharing also creates an opportunity for teens to evaluate the type of friends they want as well as the type of friend they want to be.

“The biggest factor in relapse is relationships,” said Dr. Anderson. “We ask our students to decide whether they want the kinds of friends who let them get away with things that hurt them or the type that is honest when something isn’t in their best interests.”

When teens return home, they’ll have to make similar decisions. Will they go back to their old drug-abusing crowd or make new friends who truly care about them? Can they be the type of friend that they seek? The wilderness experience helps prepare teens to make healthy decisions that are supportive of their sobriety both during treatment and at home.

Glorifying Past Drug Use Through ‘War Stories’

There is a common misconception among teens in wilderness therapy that the staff doesn’t want to talk about drugs. The truth is the staff is anxious to talk about drugs, said Dr. Anderson, but the issue is how the discussion is conducted.

“Romanticized ‘war stories’ about past drug use do a disservice because they don’t tell the whole truth,” said Dr. Anderson. “The story may convey the glory of the ‘high’ of drug use, but it ignores the disappointment in their mother’s eyes, the hangover, the lost job and their mind getting fuzzier and fuzzier.”

A teen’s ability to give a full and accurate account of their past drug use helps the staff at Outback assess their progress in the program. As students grow and learn, their war stories begin to change. What started out as a glorified account becomes a story of heartbreak when the student begins to see the reality of the experience.

“Attitudes are expressed in words, but words also feed our attitudes,” Dr. Anderson explained. “If drug use is romanticized, students aren’t processing the harm drugs cause. By continually ignoring the negative consequences, a pattern forms in the brain and the teen just continues to avoid the underlying issues.”

It is useful for newer students at Outback to hear the stories of teens who have been in the program longer because they are more truthful. This peer role modeling frees the newer students to be honest with themselves and their group in recounting stories of their drug use. Because the student is hearing the story from a peer rather than a therapist, field instructor or other authority figure, it has even greater impact.

Using Ritual and Ceremony to Address Emotional Issues

Ritual and ceremony are an important part of wilderness therapy at Outback. These experiences give teens an opportunity to work through emotions and make connections that may not be feasible in real life. They also help teens work through underlying emotions that can sabotage their recovery. For example, teens can make amends with people they’ve hurt even if they can’t go back and fix the damage in person.

“Ritual and ceremony create new ways to connect with people and emotions and build the strength and motivation to change,” said Dr. Anderson.

In order to reinforce and encourage students, Outback uses a token system that recognizes positive character traits and efforts. One student at Outback, who failed to connect with his father and lost the opportunity when his dad died from cancer, was able to work through his feelings of guilt through rituals and symbolism. The student participated in rituals around grief and loss and carried a token with him as a reminder to become the person his father always believed he could be. That token kept him motivated to stay sober.

Although relapse is a normal part of addiction recovery, it is not inevitable. Teens can avoid the heartache and disappointment of relapse by creating a relapse prevention plan and learning new coping skills. Success means embracing new attitudes and making recovery a priority every day.