Why People in Recovery Should Stop Focusing on "Relapse"
We need to stop talking about relapse as failure.
Posted April 1, 2021 | Reviewed by Gary Drevitch
- How we name a problem influences our understanding of it, and the solutions we seek.
- In recovery from addiction, the term "relapse" implies failure while the alternative term "recurrence" may lessen stigma and promote new approaches.
- Recurrence prevention for those in recovery may involve cognitive therapy, social support, honesty, and self-care.
Due to the innate complexity of addiction, its definition has been difficult to establish, and public understanding is skewed. Addiction has more recently been compared to chronic diseases. This connection has been mostly successful in helping people better comprehend addiction while setting aside the shame and judgment that used to overwhelm the idea. However, the continued use of problematic terms like “relapse” when talking about substance use disorders (SUDs) reveals that comparing addiction to other medical issues can be a reductive approach and does not capture the intricacies of maintaining sobriety.
Language Has Consequences
We live in a postmodern world in which sensitivity to the narrative and the language that constructs reality is stronger than at any other time in our history. Therefore, how we “name” (define) an event often impacts our “understanding” (etiology) of the problem, which influences how we “deal with" (treat) the problem. The misuse, abuse, and/or inappropriate use of a term can have a lasting impact on our ability to address the issue.
The term “relapse” has been criticized and considered less appropriate in depicting the full, and therefore, correct, picture of a person in recovery and their struggles. Again, the biggest issue with the term is that it still carries a black-or-white, dichotomic view of success versus failure in addiction treatment: If the person is sober, treatment is a success, but if they have relapsed, treatment has been unsuccessful.
William Miller, Emeritus Distinguished Professor of Psychology and Psychiatry at the University of New Mexico, describes how the term “relapse” denotes very limited all-or-none thinking. This perspective leads to an inaccurate understanding of how recovery works: the belief that either a person abstains from substance use; otherwise, they are out of control. Miller (2015) points out the discrepancy between how mental health issues are addressed compared to physical health conditions, observing, “People with diabetes who appear in the emergency room in glycemic crisis are not told that they have relapsed.” Why would we say this about people with substance use disorders?
Viewing relapse as a failure can be unhelpful for several reasons. First, it can foster an overly simplistic view of addiction while objectifying the individuals struggling with the condition. Also, it can be inconsistent with the zeitgeist and the subsequent culture of modern times, when society is becoming more open-minded and more high-profile figures are sharing their personal experiences with mental health and substance use disorders.
The truth is that a person’s work can never be done if they struggle with addiction; it is a condition that requires treatment providers and patients to remain diligent in order to provide the most relevant, up-to-date, and accurate treatment. The common but unrealistic expectation that completing treatment is all that is needed to remain sober can lead to irrational fears around relapse and discourage individuals from seeking help to get back to recovery. Considering that addiction is, in a nutshell, the dysregulation of motivation, having unmanaged expectations and false perceptions can lead to a significant barrier in one’s recovery.
So, before getting into any details about “relapse,” we need to rename the term. By doing so, we can reframe the problem to fit how addiction is viewed today, not 20 years ago. For example, the goal of a therapy session should be “recovery maintenance” rather than “relapse prevention” to reflect the potential positive outcomes of treatment rather than emphasizing the possibility of setbacks.
The most frequently used and preferred terminology in place of relapse is “recurrence." As a first step toward reducing the stigma that surrounds addiction, both providers and the clients should get used to using this language.
Preventing a Recurrence
As mentioned above, as addiction knowledge evolved with its known complexities, the treatment methods and the ideas around it have also grown exponentially. When educating about and practicing recurrence prevention, it is important to keep conversations simple, practical, and sustainable. Preventing a recurrence involves the following principles:
- Stay engaged and involved in recovery-oriented activities. Clients often refer to it as, “Do the recovery; then you won’t relapse.” In other words, create a new routine that is most conducive to recovery. One of the easiest ways is to seek and receive treatment as well as participate in support groups including Alcoholics Anonymous (AA).
- The next idea is understanding the gradual stages of recurrence and recovery (Melemis, 2015). This is a process of personal growth with developmental milestones and corresponding risks of recurrences. Therefore, the main goal of recurrence prevention is to help individuals realize the initial signs, recognize their triggers, and form healthier patterns during the early stages, when the chances of success are known to be greatest.
- Last but not least, cognitive therapy is still one of the most fundamental and effective tools in relapse prevention when paired with mindfulness and other behavior-oriented approaches. One of the biggest barriers to someone feeling motivated in recovery is that sobriety is “boring” and there is no room for “fun,” creating a dreadful environment in their recovery journey before it even begins. This misconception needs to be changed to the idea that recovery can be, and is, fun. This cognitive change would then be carried out through different recovery-oriented activities, while using mindfulness and relaxation-oriented practices to manage day-to-day stress and build the resilience and discipline required in recovery.
Here are some additional guidelines for maintaining recovery:
- Refrain from isolation, ask for help, and stay connected. Addiction is a condition best characterized by isolation, separation, and disintegration. Often, individuals overlook that isolation means not only separating from others but also disconnecting from oneself.
- Prioritize self-care. In recovery, self-care is one of the most important resources that need to remain abundant. Individuals are encouraged to relax through a mindful practice, rest by getting enough sleep, and nourish themselves with healthy food intake.
- Practice. Consistency is key in recovery, as it is the process of replacing old patterns of behavior with new ones.
- Maintain honesty and transparency and make no exceptions. The quickest path to isolation is to lie. To avoid recurrence, be sure to avoid bending, negotiating, and justifying harmful behaviors.
So, what do you do if the episodes of using recur? You go back to step one of your plan and repeat. Through such practice and repetition, individuals watch themselves grow through the stages of recovery. Practice does make things better, if not perfect.
Melemis, S. M. (2015). Relapse prevention and the five rules of recovery. The Yale Journal of Biology and Medicine, 88(3), 325–332. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553654/
Miller, W. R. (2015). Retire the concept of “relapse.” Substance Use & Misuse, 50(8-9), 976-977. https://doi.org/10.3109/10826084.2015.1042333