My Loved One Isn’t Staying Sober. Now What?

They promised. They swore that the last time they drank alcohol or used drugs was the last time. 

But it wasn’t. Now you’re likely left wondering, “How could this have happened?” 

When someone you love relapses, it can feel devastating. Maybe they have maintained sobriety for a few days. Or maybe it’s been weeks, month, even years—regardless, it’s understandable if you’re feeling sad, angry, defeated or hopeless. 

It’s important to know that there’s more to your loved one’s relapse than a simple yes or no decision to drink or use substances. Addiction, clinically known as substance use disorder, is a confusing and often misunderstood disease. It wreaks havoc on relationships, careers, and mental and physical wellness. And in the case of a relapse, it can happen when you’re least expecting it.  

Whether this is your loved one’s first relapse or you’ve been in this situation before, please know that there is still hope. Here’s what you can do to better understand and help your loved one.

1. Recognize addiction as a chronic disease. 

Millions of American families are impacted by addiction. Still it’s wildly stigmatized, which leads to feelings of embarrassment and shame for those with the disease and their loved ones. If someone in your life is struggling with addiction, that shame can be decreased through the power of understanding. 

Let’s start with the medical definition of substance use disorder.  

According to the American Society of Addiction Medicine, addiction is “a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Many refer to it as a “disease of the mind, body and spirit” because it involves both a physical and psychological craving or compulsion to use mood-altering substances, such as drugs and alcohol. 

It’s important to note that addiction is classified as a “primary disease” because it’s not the result of an outside situation, problem or health issue. A struggling relationship, difficulties with money, trauma—while all of these can complicate addiction, these issues, yourself and your loved one are not at fault.  

Even though addiction is a chronic disease—like diabetes, asthma and hypertension—many struggle to view it through the same lens. For example, when someone has an asthma flare-up—comparable to relapsing—they’re given the tools needed to effectively manage their chronic disease on a daily basis without judgment or shame. 

Just like any chronic disease, it’s normal and expected for those battling addiction to cycle through phases of sobriety and relapse (or the recurrence of symptoms). The medical community also classifies substance use disorder as a disease because of these criteria:  

• There are observable signs and symptoms

• It has a biological origin (is passed down through genetics) 

• There’s a predictable progression

• It’s responsive to treatment  

Viewing your loved one’s struggle with addiction through the lens of a chronic disease may help you cope with and understand their experience with relapse and remission better. Taking this view can also decrease the shame and embarrassment you may be feeling about the disease.  

2. Know what increases the chances of a flare up.  

Chronic disease flare ups, known as relapse in the case of addiction, can be sparked by various factors. One of the major challenges people have in staying sober is feeling shame or the perception that loved ones are ashamed or embarrassed. 

Whether in sobriety or facing a relapse, someone struggling with addiction may be afraid of how they and their behaviors might appear to those around them because throughout the course of this disease they’ve likely done things not aligned with their normal values systems. Lying, stealing, disrespecting their family, friends or significant others—it creates a devastating amount of guilt and shame. 

Relapsing can bring even more shame and secrecy. If your loved one is feeling too guilty or ashamed to admit that they’ve relapsed, the cycle of using is more likely to continue. 

In addition to shame, there are many other factors that can play a role in relapse, including: 

• A lack of support
• People enabling the disease symptoms 
• Unmanaged co-occurring mental health issues
• High levels of unmanaged stress 
• Unawareness of personal triggers and warning signs of relapse

It’s worth mentioning again that relapse is a normal part of living with a substance use disorder. Drug and alcohol counselors and clinicians will even tell you that it’s an expected part of recovery. This is in part because the disease is chronic. But it’s also important to remember that it’s because those suffering from a substance use disorder move through different stages of change. For example:

• Some will flat out, 100%, say they don’t struggle with addiction
• Some realize they have a problem but aren’t completely convinced 
• Some accept that they have this chronic disease but aren’t ready to fully commit to recovery
• Some are ready and willing to commit to recovery but continue to struggle 

3. Recognize the places in your life where you have control. 

You love your loved one. We know that—or else you wouldn’t be here trying to understand their disease better. However, we also know that living with someone who is struggling with addiction is extremely difficult. You’ve seen how this disease has wreaked havoc on family and friends in the past. Or you deeply love the person they are when they’re sober and are afraid of once again losing them because, despite your best efforts, they relapse and evolve back into someone you don’t recognize. 

All of the struggles surrounding addiction are marked by significant unmanageability. In turn, this makes you feel like you’ve lost control over everything. Give yourself space. Pull yourself back from the spiraling feeling of that unmanageability returning due to relapse. And breathe. 

In this moment you are in control—you’re in control of yourself. 

Your loved one’s recovery or their battle with addiction isn’t in your control. But you do have the choice to recover as a family member. This disease affects everyone, including those who love someone in active addiction, and you have the choice to seek help for yourself. 

Reaching out for help while someone you care about is actively struggling with addiction can feel selfish. In the bigger picture, though, it’s one of the most selfless acts you can do. Seeking treatment, getting healthy, learning how to set boundaries and rediscovering yourself are the most supportive things you can do for your loved one and others in your family who are affected by this disease.  

There are many options for recovery as a support person. 

• Focus internally on yourself and your needs
• Be honest with yourself and others about what’s going on 
• Set solid boundaries with your loved one
• Allow your loved one to face their own consequences  
• Get professional support from a therapist
• Attend Al-Anon or Nar-Anon meetings to connect with people facing the same issues 

4. Discover the healthiest way to be supportive.

What does support look like when you’re trying to set your own boundaries and stop behaviors that could be seen as enabling? 

One of the best—and most challenging—places to start is separating the person from the substance use disorder. Recognizing, for example, that your loved one would never intentionally put themselves or others at risk. Yet when they’re drinking or using, they may get behind the wheel of a car and drive under the influence. 

Your loved one is not their disease. And their behavior is different when they’re under the influence than it is when they’re sober. 

Acknowledging this key difference helps you maintain a non-shaming mindset and encourages empathy. You’ll have the capacity to consider what it might be like living in their shoes. As a result, your approach to communicating with your loved one will positively change.

Your thoughts and words can evolve from “this is the way you have affected me” to “this is the way your disease has affected me.”

Next, communicate your expectations and boundaries. 

• What do you view as unacceptable and acceptable behavior? 
• In what ways are you willing to help your loved one? For example, driving them to a AA or NA, helping them schedule an appointment with an addiction counselor, getting information about treatment, etc.  
• What are your boundaries? For example, if they come home intoxicated or high, what behaviors will you accept/tolerate and what are the consequences for the behaviors you won’t accept/tolerate? 

After you’ve set your own expectations and boundaries, approach your loved one with the incredibly important question, “How can I support you in this process?” 

Depending on the stage of change your loved one is in, they may tell you they don’t need support. Or they may ask you to do things that could potentially facilitate their substance abuse. Whatever the case, don’t be afraid to be honest and assertive. This could be telling them that you think they need to go back to or seek out treatment. 

As you speak to your loved one about a relapse event or signs of a recurrence of symptoms, remember that recovery isn’t a one-time occurrence. It’s a process—a lifelong one. Part of being supportive and respectful of their recovery is acknowledging where they’re at in this process.