To understand relapse, it is important to differentiate between simple slips and full-blown relapses. A relapse is not a small slip that is self-corrected; it is a return to prior behavior.
Based on the literature regarding relapse prevention in substance use disorders:
- A lapse or slip occurs when the person temporarily returns to an old behavior they are trying to correct, but they can self-correct their issue and move forward.
- A relapse represents a situation where a person returns to their previous behavior and does not self-correct.
These boundaries are not always well-defined. For instance, a person who is constantly slipping and then self-correcting would be considered to have a problematic issue that might be a relapse.
In general, someone in recovery who experiences a minor slip and then self-corrects would not be considered to have relapsed. The person should still discuss this issue with treatment providers, peers in support groups, and family members.
The distinction between a lapse and a relapse should not infer that lapses cannot be serious or should not be addressed. There is simply an important difference between a lapse and a relapse.
Signs that a Person may be at Risk for a Lapse or Relapse
People who are in recovery for any type of substance use disorder should avoid circumstances that can lead to a lapse or relapse. Every relapse began with the first slip back to the prior behavior.
A person in treatment for any substance use disorders should become involved in a very solid relapse prevention program, which most often includes some form of substance use disorder therapy to allow the individual to learn about relapse, identify the types of triggers that can affect them, and develop strategies to avoid potential lapses and relapses.
According to the book Integrative Addiction and Recovery, there are signs that an individual is getting close to a potential lapse or relapse. These include:
- The person continues to or begins to associate with others who they primarily abused their substance of choice with.
- The person continues to frequent places where alcohol or drugs are commonly used, such as bars, the homes of individuals who habitually use drugs, and similar places.
- The person expresses the idea that just having one drink or using their drug of choice occasionally would not be an issue for them.
- The person romanticizes their prior drug or alcohol use. Romanticizing prior use is often recognized when they discuss only the positive aspects of their previous use and not the negative issues.
- The person begins to skip therapy sessions or group meetings.
- The person begins to seriously criticize others in recovery or continually criticizes their therapists or other treatment providers.
- The person stops listening to family members, others in the recovery, therapists, and physicians.
- The person begins questioning whether their past use of drugs or alcohol was actually problematic for them or whether their past use was really all that negative.
- The person begins to think that they have conquered their issue with substance abuse. They think they are cured.
- The person does not follow up on treatment recommendations.
- The person complains about being stressed or under considerable pressure.
- The person becomes very irritated, defensive, or even hostile and aggressive when the prospect of relapse is discussed with them.
- The person has experienced a lapse and been able to self-correct, but does not discuss it with their treatment providers.
Indicators of present substance use are important warning signs of a relapse, such as:
- Finding drug paraphernalia in the person’s possessions
- Smelling alcohol on their breath
- Noticing bloodshot eyes
- Hearing slowed or slurred speech
- Seeing them intoxicated
- Recognizing other physical or cognitive signs associated with their drug of abuse
How to Help the Person
If the person is in recovery, experienced a lapse, discussed it with their treatment providers, and self-corrected, the best support is to acknowledge their honesty and make yourself available if they want to talk about the situation.
It does little good to criticize someone who has experienced a minor slip and addressed the issue in treatment. Instead, acknowledging the person’s strength of character and making yourself available to them is the most productive way to express concern. In doing so, you recognize that the individual has treated the situation in a productive manner.
If you suspect that your loved one has relapsed or is about to relapse, take some time to plan your approach. Accusing someone of relapsing, even if you have tangible evidence, is often not a productive way to handle this situation. Being aggressive and confrontational often spurs a reactive response and may not accomplish very much to help the person.
Instead, the best way to approach the person is to express concern, point out factual reasons why you are worried about their recovery, and attempt to discuss the situation in a positively and openly. If there is tangible evidence that they have relapsed, such as finding drug paraphernalia, this can be presented to the person in a manner that expresses love and concern.
Show respect and listen to the person without accusing or blaming them. Instead, offer to attend a meeting or go to their therapist with them.
Unfortunately, individuals who are in the relapse phase of recovery will often begin to return to their old ways, which can include very drastic behaviors such as denial, hostility, and other negative responses that do not allow for productive discussion. In these cases, it may be best to organize a formal intervention or to discuss the issue with the person’s therapist, other treatment providers, or peers in recovery.
Attempting to exert control over a person in recovery who is suspected of relapsing often results in a reluctance to get help.
This is not to suggest that you cannot impose consequences on the person. Understand that it is up to the affected person to admit their issue and attempt to deal with the situation positively. In most cases, it is impossible for other people to force someone to stop using drugs or alcohol.
Viewing a Relapse as a Learning Experience
Although some individuals view relapses as failures of treatment, the research findings have led to organizations like the National Institute on Drug Abuse (NIDA) taking a different viewpoint of relapses. Relapses are now viewed as opportunities for recovering individuals to strengthen their treatment program instead of being viewed as failures of treatment.
Even among individuals who are involved in strong treatment programs, relapse rates are comparable to the rates of relapse that occur in many other serious disorders, like hypertension.
Relapse should be understood as a sign that the individual’s recovery program needs adjustment. The person can learn and strengthen their program of recovery by understanding that their relapse is not a failure. It may simply be part of their journey to sustained recovery.
When approaching someone who has relapsed, take these steps:
- Express concern and understanding. This is often more successful than being confrontational.
- A relapse should not be considered a sign of weakness. It should be considered an opportunity for growth.
- When an individual experiences a lapse that is self-corrected and has been reported, they should be praised, not condemned.
- There is strength in numbers. Getting as many concerned friends, relatives, and peers in recovery involved in the situation can have a positive influence on the person in recovery.
There are many signs that a person may have relapsed. The key is to get the person back into treatment and to adjust their treatment plan as needed. A relapse can simply be a stepping-stone to long-term recovery if it is properly addressed.