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:
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.
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:
Indicators of present substance use are important warning signs of a relapse, such as:
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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.
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:
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.
(November 2013). Classification and definition of misuse, abuse, and related events in clinical trials: ACTTION systematic review and recommendations. Pain. Retrieved December 2018 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5460151/
(July 2017). Intervention: Help a loved One Overcome Addiction. Mayo Clinic. Retrieved January 2019 from https://www.mayoclinic.org/diseases-conditions/mental-illness/in-depth/intervention/art-20047451
(July 2018). Drugs, Brains, and Behavior: The Science of Addiction. National Institute on Drug Abuse. Retrieved January 2019 from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery