By David Joel Miller
Is relapse a necessary part of recovery?
You will hear this a lot if you hang around treatment facilities, even self-help groups. I suppose it comes from seeing people relapse and feeling helpless to prevent those relapses. But is relapse really a necessary part of recovery?
Mostly this is applied to substance abuse, drugs, and alcohol, but more and more we are seeing that other emotional, mental and behavioral challenges can follow the same processes. People get unhealthy; they may get sick and then they recover.
Do symptoms have to get worse before they get better?
Every time one of my colleagues says that relapse is a part of recovery I cringe. It feels like saying that heart attacks are a part of treating heart disease. I do not believe that good treatment should accept any negative outcome as a part of the recovery process.
Relapse is common, but it is not universal. Some people, more than you might think, recover and never relapse. A surprisingly large number of people report that they were able to quit drugs, get over their depression and anxiety and stay quit and recovered.
So how do they do recover without relapse?
We need to talk about several things. What is recovery, what is relapse, and how do people go about changing?
Emotional challenges and substance use problems are a lot like chronic physical disorders. If you have had a stroke there has been same damage done. If you have been diagnosed with diabetes you will never be “cured.” Some changes will always remain as a result of your experience.
While you will never be “cured” you can, and most people do, recover from that disorder. The same thing happens to those people who have had an emotional or substance use disorder. They can and do recover but they are never fully cured. There is a risk that if they are not careful they may slip back into an active stage of their problem but if they are vigilant about their recovery they do not need to keep getting sick again and returning to their provider to, again and again, be treated and recover over and over.
These ideas about substance use problems and mental health problems are both included in the The Big Book of Alcoholics Anonymous. Bill W. wrote about the issues that those with Bipolar Disorder will face that may make their recovery more difficult than that experienced by people who do not have an underlying mental health disorder.
Bill W also wrote that in the early days of those who came to the program and stuck (meaning actually continued to attend and participate in the program) 50% quit drinking forever. That does not sound to me like he believed that relapse needed to be a part of recovery.
He went on to report that of the remaining half about 25 % had to quit a few times to get it right but those people did eventuality stop for good.
What about that last 25%? The big book reports that while some people never did manage to stay stopped those people, while attending A.A. were much improved. I take that to mean that while the treatment for a mental or emotional problem may not fully effect a cure, reducing your symptoms is a way to reduce the harm that a mental, emotional or substance use problem creates.
These days we are applying the stages of change model to both mental health and substance use disorders. Take a look at some of the books on how people change such as Changing for good.
I have written posts in the past on this model and how it can help you change and stay changed.
In this model, we see that people need to recognize they have a problem, gather information, get ready to change and then go through the process of making real meaningful changes in their lives. In this model, we see that maintenance, those things you need to do to stay changed once you have made a change, those maintenance steps are the key to preventing relapses.
Relapse is a failure to maintain recovery.
Relapse is not a part of recovery, but the result of failing to continue doing the things that helped you get better in the first place. Whatever you did to get your emotional problem or substance use issue in remission in the first place, those actions need to continue to be a part of your life if you want to insure yourself against relapse.
If you do relapse, do not beat yourself up. Get back into recovery and practice the things you need to stay well. Just know that repeated relapses do not need to be a part of recovery if you practice your maintenance program.
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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 check out my Google+ page or the Facebook author’s page, 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. A list of books I have read and can recommend is over at Recommended Books