A Slip is Not Always a Fall: Rethinking Relapse
The myth that every slip in addiction recovery is a relapse must end.
Is Relapse Always A Part of Recovery?
According to one of my teammates who is in recovery and supports others in achieving their recovery, the answer is:
“Sometimes, though it doesn't need to be.”
The Current Definition of Relapse Doesn’t Reflect Reality
There are multiple definitions as to what constitutes a relapse. It can be defined as a deterioration in condition after a partial recovery or a slip or fall back to a previous state or practice. Either way, the definition does not note the grey areas that actually exist when a person in recovery uses a substance again.
This belief that recovery is all or nothing and that relapse has no grey area is not only wrong but harmful. It perpetuates shame and fear. It also allows for the continued utilization of treatment services that may not be effective for the person experiencing a down period in their recovery.
When a person experiences a slip and they feel they have supports that they can reach out to…They can see that their illness has improved because this time, instead of letting the slip become a fall, they were able to be caught by their own abilities and the support of others.
Relapse is a Spectrum
Relapse exists on a spectrum. Relapse is on the more extreme end, whereas, slips, recurrences, and other types of events happen on the lower end of the spectrum. A relapse in addiction recovery, to me, can be defined better as the abandonment of all efforts and changes made in recovery work. It is when a person chooses not to or is unable to use their support resources and enters a state where they no longer utilize the skills they had acquired in making decisions about substance usage. This is very different from a slip.
The Reaction is A Key Part of the Result
When someone slips, it may just have been a one-time, short-lived moment of acting on an urge. On their own, they may address it and move forward acknowledging that stuff happens and it’s ok. We don’t always have to go to extreme reactions when someone talks about these kinds of events in their recoveries.
When a person is in recovery has a down period and they use a substance, I think the general reaction is that healthcare providers, family members, other supports, and even the person themself go to the extreme. Sometimes they respond out of fear and sometimes that fear comes across as anger. Sometimes they feel like “how could this happen, you went to treatment and you are better now.” There is a view that even the tiniest of slips is a means for the whole process to come undone.
But that’s not always the case. It is perfectly ok for people to have slips along the way. It is the reaction to these slips both personally and from others that may actually contribute to the outcome. Negative reactions to a slip can contribute to a fuller undoing of the recovery work that’s been accomplished and potentially relapse. Positive interactions that offer support and inspire hope could very well act as a protective factor against addiction disease from coming back full force.
Positive Responses Lead to Positive Change
Compassionate responses are a combination of listening, promoting what went well, and adding support to areas still in need. We need to react positively, helping people to see where they are making progress and where they are recovering. We can do this when they use recovery skills and support resources to address a slip— this is recovery. We can do this when someone’s symptoms in the form of urges or triggers rise up and they reach out for help instead of acting on those impulses — this is recovery. We can do this even if they do act on the impulse or urge and then feel able to reach out and ask for help to stop before it progresses further — this is recovery.
Slips and Relapses Are Not Unique to Addiction Recovery
Think about a person who has a heart attack or diabetes and begins lifestyle changes to better their health. Do we get as mad at them when they forget to take their medicine? Do we get as mad at them when they slip and have a donut? Maybe, but there is usually more understanding and compassion given to people in these situations. We understand that they are human and there are times when old practices are given into. Sometimes those choices do result in needing more medical attention, but most of the time that donut doesn’t do anything. We don’t call for interventions, we don’t kick them out, and we don’t give them ultimatums.
We need to adopt this mentality for people with addiction disease when they experience a slip in their recovery. There is obviously a lot of past traumatic experiences that go into the responses to slips, but we don’t have to jump to the extremes of extraordinary shaming and fear tactics. We can instead choose to understand that slips happen. We can instead choose to sit with the person and listen to them about what led to it. We can instead choose to respond with compassion and offer support to strengthen the person’s ability to react to pressure and stress.
Slips Are Not Relapses and They Do Not Always Result in Them
Relapse is a spectrum. It is not a spectrum with recovery on one side and relapse on the other. They are separate spectrums that have effects on each other. Slips don't always result in relapses and the result of a slip may actually strengthen recovery. Appropriate responses to recurrences and adequate recovery supports can help prevent that from happening. This is why understanding addiction as a disease is so important to understanding addiction recovery.
When a person experiences a slip and they feel they have supports that they can reach out to, supports that respond with compassion, and offer support instead of shame, we allow people to see that they are still in recovery. They can see that their illness has improved because this time, instead of letting the slip become a fall, they were able to be caught by their own abilities and the support of others. This is progress. This is positive change. This is recovery.