The Real Definition of Relapse and Why it Matters

Rehab Helps Thousands of Addicts Quit. It Can Help You, Too.

As an addiction family therapist, I see parents of teens and young adults who live in despair over the chaos that often comes from living with someone with an active addiction. It is difficult to exaggerate the heartache of a parent who fears the death of their little boy or girl because of addiction. They set their eyes on rehab with the expectation that it will put an end to this misery. They eagerly shell out $5,000 on an intervention and willingly prepare to spend the long-saved college fund – or take out a second mortgage – on a single episode of inpatient rehab, if only their child will agree to go!

But how many families are truly prepared for the realistic outcome following treatment? Addiction is not like an infection cured by a single course of antibiotics. Most people will use substances again after treatment and most will do it within a few months. Does this mean that treatment “didn’t work” and all hope is lost?

That depends on your definition of a relapse.

A couple months later he slips and has a few beers to comfort a heartbreak. Did he relapse?-Lara Okoloko

Consider 19 year old Jacob. He used marijuana and alcohol regularly in high school and then got into serious trouble with alcohol during his freshman year at college. After a night in the ER he agrees to inpatient treatment. Jacob returns home from rehab with 28 days of abstinence under his belt. Things are going well. He is in outpatient counseling and his goal is to maintain the abstinence he has started. A couple months later he slips and has a few beers to comfort a heartbreak. Did he relapse?

When I counsel families about their loved one’s new path of recovery, I always raise this issue. “Is there any difference between a ‘slip’ and a ‘relapse’?” I ask.

This isn’t an issue of semantics. How the family defines a relapse will shape how they respond when it happens.

If any substance use at all is defined as a relapse, it can actually increase the person’s future substance use. Imagine you have been on a new diet and sticking to it. You have even lost some weight. You go to an office party. You are hungry and everything looks so tasty. Nothing is within the parameters of your diet’s rules. Someone tells you that you must try the cookies they made. By the time you leave the party you have had at least two days worth of calories.

What now?

Here is when your definition of a relapse matters. Is all hope lost or is this a learning opportunity? There is a concept that the late addiction researcher Alan Marlatt referred to as the Abstinence Violation Effect. Or in layman’s terms, a bad case of the “screw-its.” If you think of this lapse as a failure in coping strategy for a high risk situation then you are more likely to go back to your diet tomorrow and bring a broccoli salad and supportive friend to the next office party. If you think of this calorie-binge as an indicator that you are a hopeless failure who will never lose weight, you are more likely to say “screw-it” and abandon the diet for the food you have always known and loved.

Many families find it useful to distinguish between a ‘slip’ or a ‘lapse’ as an instance of substance use by someone who has a goal of abstinence and a ‘relapse’ as a return to the pre-treatment pattern…-Lara Okoloko

Back to Jacob. He had a lapse in his abstinence, but did he relapse? Many families find it useful to distinguish between a “slip” or a “lapse” as an instance of substance use by someone who has a goal of abstinence and a “relapse” as a return to the pre-treatment pattern of substance use. When someone has fully relapsed, they slide back towards the heavy and frequent use of before. Problems that plagued them before treatment begin to return. The support system they held close is now rejected. They have likely abandoned their goal of abstinence, at least for now.

How will Jacob’s family respond? If they believe Jacob’s one night of drinking is a relapse, it is easy to feel that all hope is lost, that all gains from treatment have been thrown away. Their own reaction might unwittingly encourage Jacob to catch a case of the “screw-its.” His own counselor might do the same – telling him that he can’t return to his outpatient group now that he is no longer “sober.” I have read many “bottom-line” letters written by families coached by their loved one’s inpatient rehab counselors. Most have a common theme: even one instance of substance use and it’s back to rehab or on the streets.

What if Jacob’s family believes that not every lapse leads to a relapse? They are released from the overwhelming terror of the moment. They can take a breath and put things in perspective, allowing the fear to subside. They can encourage Jacob to reach out to his support people. They can remind Jacob of what he learned in treatment. They can tell Jacob how proud they are of the progress he has made in his recovery and let him know that all is not lost. They might encourage Jacob to use this as an opportunity to learn more about his triggers and strengthen his coping strategies. They can acknowledge the pain or fear that he might be feeling and ask how they can help. They can urge him not to “screw it all” but to stay on his recovery path.

They might encourage Jacob to use this as an opportunity to learn more about his triggers and strengthen his coping strategies.-Lara Okoloko

“Individuals with other chronic conditions usually learn to manage them, accepting that there will be some recurrence of symptoms, rather than see themselves as achieving complete remission,” says addiction writer Anne Fletcher. She conceptualizes her own recovery as a process that was “established” 31 years ago, even though she can’t claim 31 years of continuous and flawless abstinence.

This is the bad news and the good news of addiction recovery. For the family, as well as the patient, lapses are scary and disappointing. They are also a normal (although not a certain) part of the process of establishing recovery from the symptoms of a substance use disorder. Knowing this can help the family keep afloat when the waters get choppy. After all, not every wave is a tsunami.

Photo Source: Pixabay

What Are Your Thoughts on this Topic?

  • AddictionMyth

    Clearly Jacob’s problem is not alcohol but girls. He should go to a school without girls and then he doesn’t have to worry about romance disappointments and can focus better on his ‘recovery’. Or if he is gay then he should attend an all girls school as a transfer student, if they will let him. Or perhaps a Christian school in which he can learn coping strategies to deal with his urges for gay sex, perhaps he could even get special lessons from one of their expert therapists. Or he could attend a muslim school in the middle east where women must wear veils to prevent impure thoughts, and beer and sex are strictly banned for the masses.

    • George Youngblood

      In my experience running an adolescent recovery program for the last twenty years, there are some significant differences between a “pre-lapse” and a “relapse”. If a client comes in and states that they had an incident of substance use, but are interested in creating a plan to avoid abuse in the future, how can we view that through the same lens as someone who makes the choice to return to active use?
      I have been an active member of the twelve step community for half my life, but when I am at work I am not twelve stepping my clients. I am providing them information about many paths to recovery, and respecting their right to self determination.
      Please read any information you can related to Client Centered Treatment.

  • stewart mccracken

    As an addictions counselor I beleive that after treatment any return to substance use is a relapse. Do I think we give up on a client or family member because of a relapse? No. I also do not feel sugar coating a relapse and calling it a lapse or slip helps anyone. Relapse is a learning experience and not the end of recovery. As an addict I can come up with my own justifications to use again. I dont feel as a addictions counselor we need to give our clients the impression returning to use is acceptable no matter how likely relapse is. Just my oppinion.
    Stewart A. McCracken. LAC.

    • Robert Maxwell

      I have never learned a single thing from my relapses, I have only ever felt more despair and hopelessness. Therer are several times where I had slipped and desperately wanted to come back, but was told that I had relasped, that my previous effert had meant nothing so I fell apart and went full tilt. I wasnt looking for any excuse(if someone wants a reason to use again they’ll find a way), I just wanted to feel like I was getting somewhere, even if i needed to be “lied” to.

      For five years I have tried useing your way and it has been fucking useless for me.

    • Makemyburdenlight

      I agree. There was a study done between two addiction recovery facilities. One believed relapse was a part of Recovery and the other faculty believed there was no relapse in recovery. Guess which faculty produced addicts in long term sober recovery?

      The facility who believed relapse had no part of being IN true Recovery.

  • Tommietski

    Thank you AddictionMyth for that laugh! Alcohol and drugs are A problem, but they are not THE problem. The problem is Jacob’s behaviors and attitudes. Yes, he did relapse. Now what did he learn from that relapse?? As stated in the book Alcoholics Anonymous, he needs to find a relationship with a God of his understanding. He also needs to keep working on himself, learning where his thoughts and behaviors can be destructive to his life and to those who love him. I can go on and on but this is a good start!

    • AddictionMyth

      As he learned in the BB, “We must have faith 24 hours a day or we perish.” Young people sometimes have little interest in a ‘higher power’ and then what? One day they find themselves ‘powerless to their cravings’ and their higher power was out to lunch…. Then they have no choice but to overdose. AA/BB is a dangerous suicide cult for young people. That is no joke.

  • Patrick Michael Tipton

    I love this article…..

  • Cue

    I disagree with the clean time of NA and Aa, for instance I went 60 days no drugs, then slipped and got drunk and took one hit of weed. Well according to the program I have to start all over at day one. I think not, the next day or so I was right back in the saddle and havnt used since, that wasn’t a relapse it was a slip. I refuse to give up my 60 days over a slip which has caused me to have to be dishonest with my sponsor and recovery brothers and sisters. I’m keeping my days and moving forward.

  • oolala53

    Roy Baumeister, eminent researcher on willpower, found that people who went on a strict diet tended to eat out of control after they made one mistake, leading his team to call it the What-the-Hell effect. In the National Weight Loss Registry, there are many people who had failed at multiple previous attempts at weight loss who have successfully taken off a significant amount of weight and maintained the loss. When asked what made the major difference, it was that they were not willing to let slips derail them for long periods of time. I have been in a mild relapse mode after seven years of mostly compliant limiting of overeating. I had small slips in those seven years, and my recent relapse is still small in the grand scheme of things. I’m reading up on the whole addiction treatment question with an admitted bias for research that supports NOT being powerless over food. It was only when I accepted that it was likely nothing was going to take away the compulsion to eat permanently, I resolved to use strategies that would make slips less likely. This involved choosing a plan that allowed all foods, but in limited amounts and frequency as long as I continued to find eating them a joyful experience, and changing my thinking about how intolerable I found the urges. They were NEVER intolerable, being nothing akin to being burned, stabbed, or beaten, but just very unpleasant sensations of real hunger of the fake kinds of hunger such as anxiety and agitation. I decided none of these could MAKE me eat. They just made me WANT to eat, and that was a very big difference. As long as I was eating reasonable amounts of food on a regular basis, even if that meant sometimes going a pretty long time between meals, it was always my choice to either put up the admittedly extremely unpleasant urges or not, and there was no harm that was going to come from waiting them out. It was a matter of which pleasure I wanted more: the pleasure of relieving the pressure of the urge, or the pleasure of being glad later I had held out. When I got honest about that, I got better at choosing not to eat outside my plan. I feel the resolve returning if for no other reason that to prove I’m right!

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