Empowering Patients to Stay Active in Substance Use Recovery: Rachel Rohaidy, MD

When working with high-functioning patients navigating substance use disorder (SUD), long-term recovery strategies, active patient engagement, and a nonjudgmental approach to relapse are crucial aspects of the job, explained Rachel Rohaidy, MD, a double board-certified psychiatrist in adult and addiction psychiatry and codirector of the transcranial magnetic stimulation (TMS) program at Miami Neuroscience Institute with Baptist Health.

Rohaidy discussed how the evolving treatment landscape is reducing stigma around relapse and why ongoing recovery requires daily commitment, whether someone is 3 months or 20 years sober.

This transcript was lightly edited; the captions were auto-generated.

Transcript

What is your approach to getting your patients back on track when they have setbacks or relapse during treatment?

Substance use disorders are relapsing and remitting disorders. We can get things under control, some stressor happens, and [relapse] could happen—3 months after it could happen, 10 years later, we don't really know, because it's a very individualized treatment. Like I said, it's not a blanket treatment for some kind of hypertensive crisis or something [like] diabetes; it's not a scale you follow. It's very individualized, and it's very different for everybody, but absolutely, you always, and I always try to impart in my patients that it's very important to be very active in their sobriety, no matter how long they've been sober.

I do have patients who, 20 years later, are still going to their AA [Alcoholics Anonymous] meetings. They still have a sponsor, and so they are very active in their recovery. What that means is that every day they're doing something towards recovery. And then sometimes patients get comfortable: “I've done what I needed to do. That's it; let me get back to my life.” And then somewhere down the line, unfortunately, something happens, and you look for what you know and what you're comfortable in to feel relief from some kind of grief or some kind of extreme stressor.

Sometimes they do go back to using; the good thing that I've seen is that a lot of my patients—because they have that time of recovery under their belt—they don't relapse for weeks on end, as they used to. They may have a 2-day relapse or a 1-day relapse and then get right back on AA and get right back in my office and say, “Alright, let's talk about what the next steps are.” I do have the advantage of being in this clinic [where] a lot of my patients are high functioning, and they want to continue being high functioning, so they can catch themselves pretty quickly.

There’s been stigma around addiction and relapse. Can you share how the approach to treating relapse is changing?

The world of substance use is changing. There were a lot of AA followers, rooms, or whatever you want to call them, who were very strict on relapses, very strict on medication treatment, [and] very antimedication-assisted treatment—being on any substance, even if it's for your depression or your diagnosed attention deficit disorder, is bad, and you're still using a substance—that was the old way of thinking. Now I think, with the advancements in mental health, the advancements in medicine, in the way that we treat, the medical model that we follow for substance use disorders has really helped to shape what we see now, which is much more acceptance.

Yes, a “relapse is a relapse.” However, you always have to look at the positive in that it's not as bad as it once was, and you were able to recover quickly. You were able to see what you needed to do to address what was going on. We celebrate those moments instead of chastising. We have a history of putting a lot of moral basis on, “What's going on?” and “You've relapsed, so you're a bad person. Now you need to be punished.” We've gotten away from that, thank goodness, and we are being more accepting. I think that has only helped patients who deal with this disease.