Relapse is grossly misunderstood – even more so for women. Although many believe relapse is tantamount to failure, science shows that is simply not the case. In fact, women experience substance use disorder differently than men – physically, socially, mentally, hormonally, emotionally, and biochemically. Tragically, the pandemic has created extraordinary stress for women, and too many are dying of substance use and related disorders as a result.
That’s why we must approach relapse in a different way to remove the stigma and shame and address it as we would any other disease. Instead of judging, shaming, or blaming, we must change the narrative and make it consistent with other diseases like cancer, diabetes, and heart disease. We would not use the word failure to describe a breast cancer reoccurrence after remission or a second heart attack. Instead, we would recognize that a woman needed more treatment and a new strategy for recovery. The same approach must be applied to substance use disorder.
We can make a difference by educating friends, families, and communities about relapse, by changing the way we talk about women and substance use disorder and by helping women and their families recognize unhealthy patterns. We can’t accept women struggling in silence. Instead, we must empower them to ask for help and prioritize their wellness.
Relapse Starts Before You Even Pick Up a Substance
A lot of our work with women in relapse treatment focuses on what happens before she even puts a chemical into her body. We found that many women with previous recovery time returned to treatment at Caron because their coping behavior was headed in an unhealthy direction. For example, some were online shopping or gambling compulsively when their structure and support networks fell away during the pandemic. In some cases, they had not even started drinking or doing drugs again, but realized they were experiencing a high from those other behaviors like their drug of choice.
The lack of normal connection right now also increases the likelihood of them slipping into negative thinking, which can lead to using alcohol or drugs to ease the emotional pain. Thoughts like “I’m not good enough?” “Why am I like this? Everyone else is holding it together! There must be something wrong with me!” that would typically be challenged in the context of their support system were now festering in Isolation, allowing shame, self-doubt and low self-worth to grow and take over.
During treatment, we work with women to challenge these negative core beliefs and messages. It’s a process and it takes time to change their internal dialogue – but it’s critical to ongoing recovery.
"Well, I had five years sober," a woman might say, conveying her disappointment. However, we help her to understand that she still has those five years. Her recovery was not a failure, nor is she a failure.
We explain that she was doing the best she could with the skills she had at the time. Those five years are a base to build on, and perhaps she needs to learn new tools or address co-occurring mental health problems or issues of grief, loss, or trauma.
Gender Makes a Difference
It is impossible to talk about women and relapse and not address the fact that biochemically a woman is very different from a man – everything from height to weight to hip radio can make a difference. In fact, when women struggle with substances, they tend to go down that slippery slope more quickly, and they get sicker faster. In treatment, a lot of times, men talk about drinking or using for a vast period of their life and then recognizing that it's problematic, whereas women develop substance use disorders and co-occurring health issues more rapidly.
Hormones and sleep
also play an important role in a woman’s recovery and can impact relapse. Women’s hormone levels are constantly fluctuating. In the early phases of recovery, our brains are still trying to find a baseline and emotions are not stable yet. Add in hormonal fluctuation with mood swings and that can turn into a major trigger if a woman is not sleeping well or she’s craving the comfort of the substance to manage everything she is feeling.
Overcoming Barriers to Treatment
Women also play a variety of essential roles in the lives of family and friends and at work. They are often so focused on being the best mom, spouse, daughter, or employee they can be, that by the time they ask for help, they are very ill. Many also find it extremely uncomfortable to sit with their feelings and believe they are in control, when in reality their substance use is creating chaos.
It often takes the gentle and consistent prodding of loved ones to encourage a woman to reprioritize her own wellness and reengage in the treatment process. After speaking with their therapists or attending support meetings, many families reach out to us to share they are concerned about what is happening with a woman in their lives and seek guidance on how to connect their wife, mother, friend or colleague with additional help and support.
In many cases, these women have been in long-term recovery and it is not easy for them to ask for help because they were in a position of strength for so long. They had the skills and tools they needed to succeed in recovery, but they've also never experienced a pandemic, where the strategies that kept us afloat have changed so substantially.
Rediscovering Connection and Accountability
Women thrive in community environments, and much of that has been lost in the pandemic. While virtual meetings and telehealth are still highly beneficial and provide much-needed connection and therapy, the level of personal accountability and support has shifted.
With in-person meetings, the time before and after a meeting was an important part of building an informal network whereas virtual meetings tend to start and end right on time. Women log in right as the meeting is beginning and feel pressure to get back to their lives immediately, without the time they would have allocated to connect with others before or after. That may sound insignificant, but it can make a world of difference in recovery because it translates to feeling hope, unconditional love and even laughter among people who understand you and help you feel seen in the most visceral way.
A few months ago, a group of women leaving relapse treatment at Caron, noting how different life is with telehealth and Zoom meetings, created their own virtual group. Now, once a week they all check in and talk about how they are doing. They live throughout the country and attend different virtual 12-Step meetings. But the group they created has given them that sense of community, continuity, and accountability, which is amazing.
By Erin Goodhart, LPC, CAADC, CMAT, CSAT, ACRPS, CCS, CPT Provider
By Erin Goodhart, LPC, CAADC, CMAT, CSAT, ACRPS, CCS, CPT Provider