To people who've watched someone they love suffer from addiction--and seen them climb out of its embrace--one word can really sting: relapse.
It means to go back to using alcohol or drugs after a period of abstinence.
In the last of our September series on addiction, Anne Glausser explores how it happens and strategies to prevent it.
CLIFFORD: The night that I relapsed I remember sitting in my car, and my life is just like in front of me. I see faces of the people I love: my daughter's face, I see my boss' face, I see my grandmother, my mom, but that wasn't enough to deter me from using.
That's Clifford, who preferred we use only his first name.
He's now in a program run by the YMCA of Greater Cleveland for homeless men suffering from substance abuse.
In his mid-20s, Clifford battled crack.
He got clean and stayed sober for 12 years.
He had stable work in a wastewater treatment plant, and he liked it, was good at it.
But in 2008 he relapsed, and went into a four year using binge.
CLIFFORD: I smoked that rock that night and I could actually feel my brain go "Bing" like a light came on. Once that happened I found myself back and forth to the bank, back and forth to the bank.
That one night set off a string of destructive events that didn't stop until February of this year.
Clifford's story isn't unique--people in recovery for any addiction are at risk of relapsing.
Experts say somewhere between 50-90% of alcoholics and drug addicts relapse.
It’s not inevitable but some treatment specialists say it should be thought of as part of the disease.
HOFFER: The real problem in addiction is the problem of relapse and reinstatement.
Dr. Barry Hoffer was the Scientific Director for the National Institute on Drug Abuse and now is an adjunct professor at Case Western Reserve University School of Medicine.
As Hoffer and others in the field say, addiction isn't something treated once and then cured.
It needs to be managed.
HOFFER: You have to think of addiction the way you would think of something like asthma or diabetes or hypertension.
A slip is preceded by a chain of actions – addicts may not recognize them at the time but often can in retrospect.
CLIFF: What happened was the desire to be normal. You know watch TV, have a beer, go to clubs, hang out with old friends. You know I started feeding off into that, and when I fed off into that it took my focus off of my recovery.
Clifford started handling life’s problems alone.
He was going through a rough patch in a relationship.
He stopped attending group meetings and talking with his sponsor.
CLIFF: I let my guard all the way down, completely down.
Stress is a major cause of relapse.
So is being angry, hungry, tired, bored, or lonely.
All of these weaken an addict’s defenses, and make it harder to resist the comforting call of alcohol or drugs.
There's something going on physiologically here.
The brain forms powerful associations between the drug and certain people, events, and objects.
Just seeing a crack pipe or syringe can flood the brain with desire long after an addict’s stopped using.
Dr. Hoffer from Case says they've seen this in brain scans.
HOFFER: The memory circuits light up, the emotional circuits light up, because it's associated with very strong rewarding effects of 10 years ago.
The smell of smoke or a vivid dream - things like this can also trigger a long dormant craving.
HOFFER: You just have to be aware of the fact that the potential for relapse is almost always there because of the circuits that have been laid down in our brain.
For Clifford, hanging out at old haunts made him vulnerable, ditching meetings let down his guard, and stress put him over.
The chain breaks.
There are ways for addicts to steel themselves against relapse, such as changing their environment, and the people they hang out with, who are tied to past drug use.
This lessens cravings in the brain.
Group meetings and therapy can bolster a person's defenses and help them think and act differently, and take personal responsibility for their decisions.
Medications help for some addictions.
AA, the largest recovery program in the country, advocates a spiritual component too.
Clifford is restarting his recovery, humbled.
CLIFF: I fear relapse. I fear relapse. I fear relapse so much that I'm willing to do what it takes to not have to live through that experience again.
Not all recovering addicts feel they need lifetime maintenance.
Treatment specialists say those people are raising their risk of relapse.