By David Joel Miller.
At some point, every recovery program has to tackle the issue of relapse. Why after losing all that weight do people suddenly put it back on? Do all alcoholics; sooner or later pick up a drink? Once you have depression you will always have recurrent bouts right? The way in which relapses are understood separates the Stages of change model from almost every other model of recovery. I have been told more than once that relapse is a part of recovery. I am not buying that! It doesn’t have to be that way.
So if relapse were a part of recovery, every person signing up for a self-improvement program should get out their calendar on day one and plan for their relapse. Doesn’t AA even say a relapse is a part of recovery? No, it doesn’t. The AA book says that a certain percentage of people get it the first time and don’t relapse. Bill W. estimated that percentage at 50%. In the early days, it appears that a lot of people who really wanted the program and stuck with it got it the first time around. He also said that there were some people, maybe 25% who tried a few times and eventually got it. The rest were better while they were in the program but kept going in and out. The stages of change model agrees with that thinking.
So why do people say that relapse is a part of recovery? Mostly people say that because relapse happens a lot. And if relapse does happen, rather than giving up, the objective is to pick yourself up and try again. One article I read said smokers typically have to try to quit seven times. Now some people quit on the first try, a few people become nonsmokers in a few tries and there may be some people who just don’t seem to be able to quit. Any self-change is like that. It takes more than trying hard.
It is not the quitting of bad habits that is the problem. Some people quit drinking 5 or 6 times in one day. It is the staying quit that is harder. So how does someone make a change, give up a bad habit, make an improvement in their life and then stay changed?
The stages of change model says that after all that effort, that process of change, there is one more thing you need to do to stay changed. See change is not a one-time thing. Real lasting change is an ongoing process. Why do people think that they can excessive like crazy, take off a few pounds and then once they lose the weight they can stop the exercise? How many days off Heroin before it would be safe to try some drugs again? The truth is that change is not a thing – it is a process. Once you make the change you have to keep doing the process to maintain the change.
The thing you need to do to stay changed is called maintenance. To stay changed you will need to do some maintenance. If you mow a lawn once will it grow back? So if it took an increase in exercise or an improvement in healthy eating to lose weight it will require you to keep doing that work to keep the weight off. The addicted person can’t just put down the substance; they need to keep doing the things that got them sober. In the stages of change, relapse is not seen as something that is part of change it is understood as a failure to do the one remaining step in the process of change – doing maintenance.
Now, this is easier to see when we talk about weight loss or addiction but what about depression or bipolar disorder? With any of life’s problems, there are things that you can do to make the problem grow and other things that make the problem shrink. Taking good care of yourself is especially important for mental and emotional issues. So if taking good care of yourself makes you less depressed, what might happen if you stopped eating and sleeping well? Your depression might grow. The maintenance step is needed for holding onto any change you made, it is the best antidote to a relapse, whether that relapse is weight gain, addiction or depression.
Next time we will talk about the last stage of change – maintenance. After that, I want to talk a bit about some related problems like triggers and finding help when you have few resources. Till then –
For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog, there is also a Facebook authors page, in its infancy, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. Thanks to all who read this blog.
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