Relapse is Inevitable Without Medicines

Dr. SATISH RASAILY President Sikkim State Branch of Indian Psychiatric Society

A 32-year-old unmarried male, employed in a government setup, reported for outpatient drug detoxification treatment with a current relapse of nearly two months. He shared that he has been using approximately 1 gram per day of brown sugar (BS) since October 2025.

He had a history of BS addiction for several years and had undergone multiple unsuccessful treatment attempts in the past. However, during his previous treatment with substitution medicines, he achieved nearly six months of complete abstinence—the longest drug-free period of his life. He described this phase as one of the happiest and most stable periods, as he finally felt in control after years of repeated failures.

How Medicines Helped Him Stay Abstinent?

While on medicines and under regular psychiatric follow-up:

Craving control:
The medicines significantly reduced intense drug cravings. Situations that earlier triggered use—such as seeing drug-using friends, passing familiar drug-use locations, stress after work, or emotional distress—no longer felt overwhelming.

Better coping with high-risk situations:
When friends invited him to use BS, he could confidently say “no” and walk away.
During emotional stress or loneliness, instead of turning to drugs, he could distract himself, call family members, or use coping strategies taught in therapy.

Environmental cues such as seeing syringes, hearing drug-related conversations, or receiving calls from dealers no longer immediately led to relapse.

Improved impulse control:
He became more capable of thinking before acting, rather than impulsively using substances to escape discomfort.

Psychosocial and Social Improvements:

With consistent medication, expert psychosocial therapy, and guidance from his doctor:

His relationship with parents and relatives improved significantly.

He no longer needed to hide or lie about his behavior.

The constant fear of being caught by the police disappeared.

He could save a substantial portion of his income, which was earlier spent on drugs.

He regained self-respect, confidence, and dignity.

He felt empowered to fight the internal “demons” and external threats that previously led to relapse.

Stopping Treatment and Relapse
After six months of treatment, he began to feel that he was “completely cured” and no longer required medicines. Believing that he could manage on his own, he stopped medication, although he continued occasional therapy visits.
Initially, he managed to control urges for a few months. However, under renewed peer pressure, he gradually restarted BS use. Once use resumed, control was quickly lost, and he returned to daily consumption.
He wanted to seek help earlier but intense guilt, shame, and fear of judgment prevented him from coming back. Eventually, his physical and mental condition deteriorated to the point where he felt that if he did not seek treatment again, he might die.

Doctors’ Advice and Motivation

The treating doctors reassured him and explained:
Relapse is not a failure; it is part of a chronic illness.
Addiction is similar to diabetes or hypertension—stopping medicines prematurely often leads to relapse.
Medicines protect the brain while it heals.
Long-term substance use alters brain circuits related to craving, impulse control, and stress. These changes take years, not months, to normalize.
Feeling “better” does not mean “cured.”
The absence of cravings is often due to the medicine working—not because the illness has disappeared.
Peer pressure is strongest when medicines are stopped.
Medication acts as a shield, reducing the impact of external triggers and emotional stressors.
Continuous treatment for at least 2–5 years.
Reduces relapse risk drastically
Stabilizes brain chemistry
Improves social, occupational, and family functioning
Builds long-term coping skills and resilience

There is no shame in returning for help. Seeking treatment again shows strength, insight, and courage, not weakness.



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