Clinicians who treat individuals with substance use disorders define the term relapse a bit differently than the way the term is defined by laypeople and even the way it is defined in 12-Step programs. In clinical terms, a relapse represents a return to behaving in a way that would constitute an individual being re-diagnosed with an active substance use disorder, such as alcohol use disorder.Relapses occur after periods of abstinence as a result of an individual trying to change some behavior, and they represent an individual going back to a previous pattern of behavior that occurred when the individual was actively involved in alcohol abuse. A lapse represents a very short slip from abstinence to one’s formal addictive ways and then the person self-corrects their behavior and goes back to their recovery plan.
Many individuals in recovery and in 12-Step groups consider a lapse and a relapse to be equivalent; however, based on the clinical definition of these terms, this is obviously not the case. Relapses represent a return to formal addictive behaviors, whereas a lapse represents a small slip and then the individual self-corrects their behavior. An individual who continues to have numerous small slips followed by short periods of abstinence would most likely be considered to be relapsing and treated accordingly based on the clinical designation of these terms. Lapses are considered to be very brief and transient returns to past behavior, whereas relapses are considered to be more long-term returns to the behavior.
The first thing to understand about lapses and relapses is that they are not rare events. Information provided by the National Institute on Drug Abuse (NIDA) indicates that lapses and relapses among individuals in treatment for substance use disorders are as common as lapses and relapses among individuals who have other types of disorders that have a significant behavioral component, such as hypertension, diabetes, and asthma. The relapse rates among individuals in recovery for substance use disorders vary between 40 percent and 60 percent, depending on the source of the data and the type of the substance being abused. In addition, it is unclear whether this data separates lapses from relapses according to the clinical designation of these terms; most likely, lapses and relapses are combined under the category of relapse.
Secondly, many individuals in recovery from alcohol use disorders and other substance use disorders view lapses and relapses as signs of failure. Nothing could be further from the truth. The attainment of most worthwhile goals occurs as a result of going through both successes and setbacks that allow for the individual to learn from their mistakes, build on their successes, and reach their final objective. It is very rare that an individual reaches a complex and difficult-to-obtain goal without experiencing at least a few setbacks. Individuals in recovery should learn to view lapses and even relapses as setbacks that offer an opportunity for them to grow stronger and move forward. Remaining committed to recovery despite setbacks is the most important factor that can foster progress.
Finally, viewing lapses and relapses as part of the normal process of recovery is not an excuse to lapse or relapse. Lapses and relapses should be taken seriously by recovering individuals and treatment providers, and they should be analyzed and understood in order to help the individual engage in an overall successful program of recovery. Just because lapses and relapses are not rare and do not represent signs of failure does not mean that it is acceptable to relapse. Relapses are setbacks that allow individuals to improve and become stronger, but they are not to be taken as an excuse to return to old ways.
Some of the classic psychological works regarding recovery from substance use disorders were written by psychologist Dr. G. Allan Marlatt and his colleagues. These books and articles offer useful clinical information regarding relapse prevention and strategies to help individuals in recovery to avoid lapses and relapses, and to overcome the disappointment and feelings of failure that come up if these events occur. Even though Dr. Marlatt’s work was targeted at professional clinicians, individuals in recovery can benefit from reading many of his publications. Some of the important points Dr. Marlatt and his colleagues provided regarding avoiding relapse during recovery from alcohol use disorders include:
Being involved in formal alcohol use disorder treatment: Individuals who become involved in formal alcohol use disorder treatment programs relapse at lower rates and recover from relapses at significantly higher rates than individuals who do not become involved in these programs. The foundation of any substance use disorder treatment program is formal substance use disorder therapy. This therapy can be delivered on an individual basis, in a group format, or as a combination of individual sessions and group sessions. Social support groups, such as Alcoholics Anonymous, are useful, but they are not formal therapy groups since they are not run by trained and licensed therapists.
Understanding one’s triggers: A good deal of the published work by Dr. Marlatt focused on how to deal with cravings and triggers, and developing strategies and techniques that can help one overcome these instances. A significant amount of time in formal alcohol use disorder therapy is also spent in preparation for dealing with cravings and triggers.
Triggers are situations or conditions (states of mind) that help to elicit cravings to use alcohol (or one’s drug of choice). Cravings are desires, urges, fleeting thoughts, etc., about wanting to use again. Triggers can be very subtle and personal, or they can be quite general and applicable to most individuals in recovery. Cravings can sometimes be very easy to identify, or they can often be very difficult to pinpoint as a craving. For instance, romanticizing one’s past alcohol use is a form of a craving for the drug. Individuals in recovery for alcohol use disorders should understand situations that are prone to triggering cravings and understand the nature of cravings, how they present, and how to deal with them. Specifically, the individual in recovery should:
Changing things around: Individuals in recovery are often required to make numerous changes. Some of the most important changes that need to be made relate to one’s friends or peers, the types of environments a person frequents, and learning more constructive ways to manage stress (see below for stress management). For many individuals in recovery, this means letting go of old friends, old hangouts, old habits, etc. Instead of adhering to these old influences, individuals are encouraged to become more involved with family, with other individuals in recovery, and in social support groups for alcohol use disorders.
Knowing that negative thinking is sometimes okay: Many people in recovery often fantasize about the positive aspects of their alcohol use. While the use of alcohol may have had some benefits at one time for these individuals, their use has become so dysfunctional that any use of alcohol is dangerous for them. Romanticizing past alcohol use is a kind of craving (see above) and does not allow an individual to fully let go of their substance use disorder. When a person begins to think about the positive aspects of their alcohol use, they should use that as a cue to concentrate on the negative aspects of their alcohol abuse. This technique is often referred to as urge surfing.
Learning to manage stress: An important aspect of recovery is learning and practicing stress management techniques. Stress becomes a major issue for individuals who are recovering from alcohol use disorders, and being in recovery can be stressful. Cognitive-behavioral techniques for stress management are typically used, and these include strategies like diaphragmatic breathing techniques, progressive muscle relaxation, mindfulness meditation, etc.
In some instances, individuals may also use sedative medications that have been prescribed by a physician for anxiety and stress, particularly if co-occurring psychiatric disorders are present. Benzodiazepines for the treatment of anxiety are considered to be a short-term strategy until the individual can learn to use behavioral techniques to manage their stress and anxiety, as these medications have similar effects to alcohol and are also highly addictive.
Addressing co-occurring issues: Many individuals with alcohol use disorders have a co-occurring psychological disorder, such as depression, anxiety, trauma and stressor-related disorders, bipolar disorder, etc. Attempts to treat a substance use disorder and ignore any co-occurring disorders are doomed to failure. Each individual needs to be treated as a whole person. This means formally addressing any co-occurring mental health disorders that have been diagnosed or identified.
Getting involved with others: An important factor in an overall successful recovery program is the presence of a strong social support group. Social support can come from many different sources, including family, friends, peers in recovery, and peer support groups or volunteer groups. Involvement with family and close friends who are committed to the individual’s recovery can be a deciding factor in the way a person deals with a lapse or relapse or even in preventing a lapse or relapse. Twelve-Step groups like Alcoholics Anonymous are also excellent sources of social support.
Keeping busy: Boredom and idleness are general triggers for relapse in a similar manner that being overly stressed or feeling overwhelmed can trigger a relapse. Individuals in recovery need to learn the difference between staying busy and avoiding boredom and overwhelming themselves. Often, this requires the assistance of family, friends, and peers in recovery. Individuals can find a number of ways to occupy their time that do not increase their stress, such as finding new hobbies, getting involved in a mild exercise program if they are healthy enough to do so, joining a book club, taking a college class, etc.
Living healthy: Eating healthy foods, getting plenty of rest, and balancing one’s life can be significant factors in avoiding issues with lapses and relapses while in recovery from alcohol abuse. There is no need to get fanatical over healthy living but following the general rules and principles of a healthy diet, getting sufficient rest, getting sufficient exercise, engaging in health-promoting activities, etc., can go a long way toward avoiding relapse.
Whether one has lapsed or relapsed, one should typically follow a general plan to address the situation. Individuals who have recognized the situation and already gone on to self-correct their behavior should still follow the sequence below beginning with the second step.
Addressing the issue as quickly as possible can help the individual to reevaluate their treatment program and make the necessary adjustments to avoid future issues. Even if one has suffered a lapse and self-corrected their behavior, it is important to discuss the situation with the treatment providers and sponsors in a 12-Step program. In addition, individuals should discuss the situation with peers in recovery, concerned family members, and others who are committed to assisting them in the recovery process.