Saturday, March 29, 2014

Slips and Relapse as Part of Recovery

Sometimes when I am in the hallways at work I am amazed how it can seem like "Old Home Week" or like a high school reunion. People are rushing around from group to their counselling appointment or outside for their afternoon break. So many people know each other and are happy to see each other knowing that they are back on track.

It is unfortunately quite common for people to slip or relapse while working on recovery. Not everyone does and it is certainly not a requirement but it does happen. The best one can do with this is to learn what went wrong and then specifically work on that trigger so it does not "take them out" again. The shorter a relapse (if it's only a day or so it is sometimes called a slip) the easier it is to get right back on track. When a real relapse does happen it can last for a month or two, or for many years.

Each attempt at recovery is not necessarily the same as the one before. Sometimes people find it much harder the second or third or fourth time around, but not always. The path to recovery is not necessarily a straight line and can be very unpredictable. Unfortunately some people actually die when they relapse. This can happen sometimes due to a change in tolerance for the drug, where they unintentionally overdose even though they used the same amount they used to use. This is tragic and so very hard to deal with.

Even though this may make us want to yell "Danger, danger" to the addicted people we know, fear is not always a good motivator. It is human nature to think, or at least strongly believe, that the worst will not happen to us. Instead success requires actually wanting to change ourselves. It is change of behaviour, change of thinking, change of how one handles emotions, that makes the difference to achieving a solid recovery. 

People go through stages of readiness to change. The Transtheoretical Model of Change is the model  we use to explain this. The six stages of change are pre-contemplation, contemplation, preparation, action, maintenance and termination. If someone has not even begun to think about whether they have an addiction or not, they are said to be pre-contemplative. If they are thinking about it but have not yet decided, then they are contemplative which also looks a lot like ambivalence. Once a decision to change has been made a person is said to be in preparation. This is the planning stage of how they will go about their change. Next people are in action when they are actually changing their behaviour. Finally maintenance is when the change is quite solid and is not so much active hard work anymore. Termination is when the change is "done" as in the smoker who is now at heart a non-smoker. In the world of alcohol and drugs many believe that termination is never reached, and that maintenance of  recovery is as good as one can do.  This might be true, as for many if not most, relapse is only a drink away no matter how much time has passed. It seems as if the addiction is only "asleep" rather than really gone.

The very good news is that there are people who succeed.There is a movement growing in the States where more and more, those who are successful in beating addiction are willing to let themselves be known openly.  I am excited about this trend and believe these brave people can offer so much inspiration and hope to those who are still stuck in the relapse/recovery cycle.

Source: Prochaska, J. O. & Di Clemente, C. C., (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research and Practice, 19(3), 276-288. Figure 2, p. 283

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