DISCLAIMER: Amanda Bynes’ battles with addiction and mental health issues are well-publicized. Now that reports have come out about her current situation, we will look at how stress can affect addiction and In November 2018, in an interview with Paper magazine former Nickelodeon star Amanda Bynes made several refreshingly-candid revelations about her history of bizarre behavior. According to the 32-year-old actress, the public meltdowns she experienced a decade ago were caused by a serious drug problem, specifically involving marijuana, cocaine, ecstasy, and especially Adderall, the prescription stimulant typically given to patients with ADHD. The purpose of the interview was to not only to come clean about the past, but also to embrace the future. Bynes announced that she was four years sober and ready to resume her acting career. Now, there are new reports from multiple sources saying that Bynes relapsed and checked into a rehab facility in January. There, she is receiving care for both substance abuse and mental health problems. Unfortunately, though, Bynes’ relapse isn’t unusual. In fact, MOST alcoholics and addicts in recovery will relapse to a degree at some point. It’s what happens next that matters the most. Let’s take a closer look at what relapse is, as well as what factors may have contributed to Amanda Bynes’ current struggles. Perhaps in this way, we can help someone else who is in crisis right now.
What is a Slip?
A slip is an error in learning… (People) who recover from habits they want to change treat slips very differently. They see themselves as having made a mistake they needn’t repeat. And RECOVERING from a slip gives them stronger confidence in their ability to resist temptation.” ~ Dr. G. Allan Marlatt, the University of Washington If active addiction is a pattern of uncontrollable drug or alcohol abuse combined with negative, harmful behaviors, then a “slip”—also called a “lapse”—is a single episode or short period of use after a period of sobriety. A lapse can last anywhere from one evening to a weekend to several days. What is important and what separates a slip from a relapse is that the person does not completely stop working their recovery plan. In fact, most people who briefly lapse quickly realize their mistake and start working their plan higher than ever before. In some ways, that is what a slip or relapse really is—a call to attention that the person needs to readjust or rededicate themselves to their sobriety plan.
What is a Relapse?
“A chat with the Grim Reaper should be enough to scare away any thought of relapse. Wish it were that easy, but not even days conversing with Death can disintegrate the claws of addiction.” ~ Ellen Hopkins, Traffick An actual relapse, however, is both longer and more serious. A relapse is a lasting return to not just active drinking and drugging after a period of abstinence, but also to the dysfunctional and destructive thoughts, attitudes, and behaviors that accompany the disease of addiction. In other words, one drink or pill or bump doesn’t mean the person has relapsed. But if the person drinks or uses, again and again, starts lying and manipulating others, and overall, seems to have abandoned their efforts at sobriety and healthy recovery, then they are suffering a full-blown relapse. If a slip is a single short episode, then relapse is a prolonged series of episodes.
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Relapse Happens in Stages:
FIRST STAGE: Emotional Relapse At this point, the person is not drinking or using drugs yet. In fact, they are probably not even consciously thinking about it. But they are experiencing turbulent emotions that increase the likelihood of relapse.
- Mood swings
Although virtually every person in early recovery experiences this kind of emotional roller coaster, someone who is emotionally relapsing will not do anything positive to counter these negative feelings. SECOND STAGE: Mental Relapse By this stage, the addict/alcoholic IS consciously thinking about getting drunk or high again. And because they have been sober for at least a little while, they are desperately wrestling with themselves about what they will do next.
- They DO NOT want to use or drink, because they know that it is bad for them and could disrupt their entire life.
- They DO feel a strong compulsion to start again. Something has triggered cravings that are too strong to ignore.
Without a strong and involved support system and a relapse prevention plan in place, a mental relapse swiftly becomes a physical one. THIRD STAGE: Physical Relapse Now, the person is actively using again. They are no longer working their recovery plan, and their addiction is once again controlling their actions.
Isn’t Relapse Inevitable?
“Relapse is totally avoidable…The more knowledgeable you are about how to minimize the risks and knowing relapse warning signs will help you know what recovery skills to be practicing, especially if you feel in danger of relapse.” ~ Dr. Bill McCausland, Ph.D., Successful Recovery and Relapse Prevention There is an often-repeated saying that “Relapse is part of recovery.” Not only is this statement wrong, but it is also actually dangerous because it implies permission for someone in recovery to “try” substance abuse again. To be clear—it is NEVER okay or a good idea for someone struggling with any Substance Use Disorder to go back to using or drinking. The mindset that relapse is inevitable or unavoidable becomes a self-fulfilling prophecy. In other words, the person sets themselves up for failure. In fact, a better way to put it would be “Relapse is part of the DISEASE.” Once someone’s brain has been altered by chronic substance abuse that progressed to addiction, they will ALWAYS be exceptionally vulnerable to all intoxicants. This is why structured, evidence-based treatment, long-term aftercare, continued support, and dedicated lifestyle changes are so important to avoid relapse and promote successful recovery.
Lapsing and Relapsing: The Statistics
But all of that being said, the risk of a relapse is real, and it is an unfortunate reality for most recovering alcoholics and drug addicts. Up to 90% of people in recovery experience a mild-to-moderate lapse/relapse at some point. The drug of choice matters as well. For example:
- 4 out of every 5 heroin addicts will relapse 8-10 times before successfully achieving lasting sobriety.
- Intravenous opioid users have a relapse rate that is more than double than of addicts who do not inject drugs.
- Among opioid addicts, every day of benzodiazepine use increases the risk of relapse by 7%.
But as scary as those statistics may seem at first, they actually compare favorably to other chronic diseases such as asthma or diabetes. In fact, if you consider noncompliance with a doctor-recommended treatment plan roughly equivalent to a full-blown relapse, then the picture becomes even clearer.
- Between 40% and 60% of people with SUD will suffer a full-blown relapse
- 30% to 60% of diabetics are not in compliance with their diet, medication, and exercise plan, meaning their disease is not properly managed.
- 50% to 70% of people with diagnosed high blood pressure do not properly take their medication or follow their diet plan.
- Likewise, between 50% and 70% of asthmatics have poorly managed symptoms because they don’t take their medication properly.
- Almost 70% of people with Bipolar Disorder relapse to the point of needing hospitalization and/or medication adjustment. Of special relevance, Amanda Bynes has tweeted about having BPD.
- Over half of patients with schizophrenia will re-exhibit psychotic symptoms within three years of their initial treatment. Also significant is the fact that Bynes was diagnosed with schizophrenia in 2013.
One thing that all of these diseases have in common is how they are treated. In addition to professional intervention—medication, education, counseling, etc.—each requires the patient to make significant lifestyle changes that support healthy management of their illness to prevent relapse and progressively worse symptoms.
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Stress and its Role in Addiction and Relapse
“Drug addiction is clearly a stress-sensitive disorder and has even been described as a stress-related disorder…women are generally recognized as having an increased sensitivity to stress and a heightened stress response…” ~ Women and Addiction: A Comprehensive Handbook, edited by Kathleen T. Brady, Sudie E. Back, and Shelly F. Greenfield By all accounts, Bynes’ relapse was caused by the overwhelming stress of re-entering the public eye. As promising as her interview for Paper was, and as positive as the reception was, Bynes still had to have felt enormous pressure to live up to that promise. And that pressure is what seems to have triggered her relapse. TMZ reports that “…the pressure of being back in the public eye and auditioning in Hollywood again…was just too much, too soon for Amanda”. There is a biological reason that supports this. In early 2017, a study published in Neuron concluded that acute stress “recalibrates” a person’s brain at the neurological level, thereby making that person more likely to abuse substances. Specific neurons within the brain’s reward center are turned off after exposure to acute stress. These wounds are responsible for moderating alcohol intake. When they are switched off, the brain mistakenly incentivizes continued drinking. It is theorized that these neurons’ ability to turn on and off is an evolved biological trait allowing humans to recover faster from trauma or injury. But it also explains why some people are prone to self-medicating with drugs or alcohol when they feel overwhelmed by stress.
Toxic Shame is a Primary Factor
“I’m really ashamed and embarrassed with the things I said. I can’t turn back time, but if I could, I would. And I’m so sorry to whoever I hurt and whoever I lied about because it truly eats away at me. It makes me feel so horrible and sick to my stomach and sad…it’s my own fault.” ~ Amanda Bynes Part of the stress Amanda Bynes must have experienced comes from shame, guilt, and embarrassment because of her very-public meltdowns in the past. Look at the words she used—“ashamed…embarrassed…horrible…sick…”. In fact, those are very common emotions for people in recovery, and they are not helped by the societal stigma attached to addictive disorders. Too often, people with SUD feel or are made to feel that their illness is somehow their fault as if it is the result of some weakness or moral failing. Even when they are still in the early stages of relapse and before they have actually started to use or drink again, people in that situation start to feel guilty and ashamed over their own thoughts. They convince themselves that they shouldn’t feel that way, and to them, that’s just further proof of how weak and wrong they are. And if the people around them also admonish them for “not being strong enough” or “not using their willpower”, then their shame grows even deeper. But shame and other negative emotions are counter-productive. Because as Jessica Tracy and Daniel Randles with the University of British Columbia said, “Our research suggests that shaming people for difficult-to-curb behaviors may be exactly the wrong approach to take. Rather than prevent future occurrences of such behaviors, shaming may lead to an increase in these behaviors.”
Responding to a Relapse
“A lapse or relapse doesn’t mean the end of your recovery. Your life doesn’t return to the previous chaos just from one lapse or relapse. Recovery is stability, stable psychological status to which you can return even after a lapse if you promptly correct it and not let it turn to loss of control. You don’t go all the way back to the start just from a lapse once you begin recovery.” ~ Scott Stevens, Every Silver Lining Has a Cloud: Relapse and the Symptoms of Sobriety Here’s the good news for Amanda Bynes or anyone else struggling to stay sober—it is possible to overcome a relapse. It does not have to mean that treatment has failed or that recovery is impossible. What it DOES mean, however, is that there needs to be adjustments to the recovery plan. Maybe additional therapies or increased frequency of services is required. Perhaps an anti-addiction medication is appropriate. In any case, a person who has relapsed should re-dedicate themselves to complying with their recovery plan. This may require them to:
- Make a stronger effort to avoid triggers—people, places, things, and thoughts that they associate with substance use.
- Go to more 12-Step fellowship meetings.
- Learn and practice positive coping skills.
- Use stress reduction techniques.
- Check into a rehab program
- Talk to their recovery physician about Medication-Assisted Treatment
Here’s the good news—today, a person who has relapsed has more information, support, pharmacological options, and evidence-based treatment services available to them today than ever before.
What’s Next for Amanda Bynes?
“Amanda is continuing treatment with the assistance of mental health counselors and addiction specialists. (She is) responding very well to treatment and her team remains extremely optimistic about her future.” ~ Us magazine Even before this latest setback, Amanda Bynes faced several significant challenges. Along with her problematic substance abuse, she also reportedly suffered from mental illness, in the form of schizophrenia and Bipolar Disorder. When addiction and mental disorders co-occur, this kind of dual diagnosis can complicate recovery. This happens more than you might think. In fact, 72% of people who are addicted to drugs have at least one psychiatric condition. Amanda Bynes has at least two. Prior to relapsing, it as evidence that Bynes still had a way to go. For instance, even though she reported that she was four years sober, her affairs were still handled by a conservatorship. That seems unlikely now to change anytime soon. Despite her wish to resume her acting career, her first, perhaps ONLY priority needs to be her sobriety and good mental health. Everything else that she could ever want to accomplish must start there. In a very real way, Amanda Bynes is an extremely lucky woman. She is not going through this alone. Her parents have stood beside her the whole time, sometimes making the tough calls needed to protect their daughter. Although she has struggled, she hasn’t lost her fortune, her home, her freedom, or her life. She is still young enough to have a long, bright future ahead of her. And when she is healthy enough to leave the treatment facility, hopefully, she will have learned healthier ways to cope with negative emotions and stress. The ability to practice those skills that support her successful sobriety will serve her well for the rest of her life, one day at a time.
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What Can We Learn from Amanda Bynes’ Struggles?
“The longer we stay sober, the more we need to know to maintain a sense of meaning, purpose, and comfort… the recovery process forces us to keep growing, learning, and changing.” ~ Terence T. Gorski, Passages through Recovery: An Action Plan for Preventing Relapse The first takeaway is this—addiction and relapse can happen to ANYONE. This disease does not respect the boundaries of success or privilege. Amanda Bynes is young, rich, beautiful, talented, successful, and surrounded by people who care about her. She still struggles. Next, a relapse can happen AT ANY TIME. Just a few months ago, Bynes achieved four years of sobriety and felt confident enough to announce her return to acting. This relapse highlights how dangerous complacency is. Amanda Bynes’ current situation shows that recovery is a lifelong process that is best supported by actions and adjustments that are made one day at a time. Also, this demonstrates how important it is to have a strong support system in place. As serious as this situation is, it could be much worse if Amanda Bynes did not have the love and the help of her parents. Finally, although the final chapter of Amanda Bynes’ a story has yet to be written, there is every reason to believe that she will successfully recover and move forward in good health. The rehab facility is absolutely the best place for her right now, and there, she will be taught the skills and be given the tools necessary to craft her own sobriety. We here at Northpoint Recovery wish her the best in her recovery.