Noun: A deterioration in someone's state of health after a temporary improvement.
Verb: (Of someone suffering from a disease) suffer deterioration after a period of improvement.
The word "relapse" is improperly used when a person is recovering from an addiction. According to the above definition, a relapse constitutes suffering deterioration. Meaning, that life has deteriorated after a period of abstinence. Fundamentally, the word "lapse" is defined as "pass gradually into (an inferior state or condition)." Hence, a person needs to continuously lapse to relapse and once again reach a debilitating state where the need for professional help is necessary.
If diagnostic criteria for a substance use disorder have not been met for 3-12 months, then the disorder is in "early remission." If not met for over 12-months, then it is considered to be in "sustained remission."
To diagnose someone with a substance use disorder they need to exhibit at least two symptoms for it to be considered a "Mild" substance use disorder.
See Chart for Diagnostic Criteria:
Therefore, we can view the word "lapse" as a "slip." If a person survives the slip without fatality, the only thing they usually lose is time abstinent. This has minimal impact on a person's quality of life. They do not meet the diagnostic symptoms that constitute any level of a substance use disorder. Because they do not meet diagnostic criteria, slip or no slip, their substance use disorder is still considered to be in remission.
Additionally, in the revised version of the psychological Diagnostic and Statistical Manual, version five, they had taken out the diagnosis for a "Polysubstance Addiction." Each drug is now its own disorder, and must be assessed individually. Which means, that if a person abstains from their drug of choice but uses another drug, this is not considered a lapse or a relapse. The potential for addiction is there, but that needs to be monitored on an individual and ongoing basis.
Just because someone seeks treatment for an opiate use disorder and they smoke pot or have a drink down the line or even on a social basis, this does not mean that we need to generalize, scold, and/or stigmatize them, while convincing them that they will automatically revert back to their drug of choice or develop a new substance use disorder to the other drug. This type of programming could result in a self fulfilling prophecy where the former or current drug user's perception of their use of another substance results in giving up on their recovery and going back to using their drug of choice and dropping out of treatment or recovery based on the misinformation they received about this type of scenario.
Most people who try most drugs do not develop a substance use disorder. But some people do, roughly 10%. Anything can be addictive: shopping, food, sex, internet, gambling, etc... So it's not the drug itself, per say. Yes, some drugs carry the risk of physical dependence. But physical dependence alone does not qualify someone to be diagnosed with a substance use disorder. Methadone is a good example. People have a misconception that if someone is on methadone, they are "still using" despite significant improvements to their quality of life. The same applies to certain psych meds as well. This lies in the assumption by some recovering people who may have had an addiction to a substance that is legitimately prescribed to another recovering person who is able to take it as prescribed without loss of control or developing a substance use disorder to the prescribed medication. Individual views about certain drugs create the belief that it is the drug that causes the addiction generalizing that a substance that may have caused one person to develop an addiction will do the same to everyone who tries that particular drug. It's like saying that no one should shop, eat, or gamble because these are addictive behaviors for everyone. These factors have an impact on how a person who has a substance use disorder reacts if they slip while being a member of an abstinence based recovery support group. It is important for people to find the type community support group that will enable them to improve their quality of life without basing their personal definition of sustaining recovery on time alone as the primary factor.
There are many variables that can create an addiction. They need to be addressed individually, adequately, thoroughly, and simultaneously in treatment. If only focusing on abstaining, a person who is in remission from a substance use disorder will most likely relapse. It's like having any other chronic medical problem (cancer, diabetes, plantar fasciitis, arthritis, pain, etc.) and utilizing only one type of treatment repeatedly, despite other options out there that may be a better fit. Yes, this one-type of treatment may work for some patients but the assumption that it will work for all is wishful thinking. Even worse, is blaming the person who is struggling with a substance use disorder if only one type of treatment and recovery have not worked for a particular individual. This results in feelings of hopelessness, shame and guilt for the person suffering. If a person feels ashamed about a lapse, this may lead to dishonesty about their use to save face, denying them the opportunity to address it with professionals as soon as it happens, until their lapse has become a full relapse and they are back to a debilitating state.
Unfortunately in treatment there seems to be a consensus for the one-size-fits-all approach that is rooted in the 12-step modality, it is called 12-step facilitation. This model places too much emphasis on time abstinent as the primary definer of successful recovery. The premise of this type of treatment is based on the personal experiences of addiction and recovery by fellow peer and paraprofessional counselors who lack the training and knowledge of how to address biological, psychological, and social issues that affect the addiction. Their views see the situation as vice versa. But asking if the addiction caused the problems, or the problems caused the addiction is like asking about the "chicken and the egg." For most of the addicted population, removing the substance use does not remove the biopsychosocial problems that underlie it, thus resulting in chronic relapse.
Additionally, there is the belief that no other problems can be addressed until a person has a certain amount of time abstinent before making certain changes to improve their quality of life. In the meantime, the former user is forced to live with all the stressors that have developed over the course of their drug use. There is no wrong door to begin treating an addictive disorder. It is important to meet the client where they are, and work with them to solve any protruding problems. If we can remove or minimize past or present life stressors from the get go, then these stressors will no longer emotionally trigger the user to lapse or relapse.
Someone who has been abstinent for any amount of time and has a slip, they are still considered a success. Addiction is a progression that can take years to spiral out of control. Recovery as well is a progression. Minor slips and setbacks along the way are a normal occurrence. It takes time for someone to develop a severe substance use disorder, so expecting someone to just stop their only way to cope with life without replacing that with healthier coping skills is not a good idea.
Why Most People Relapse
Integrative treatment can be done completely on an outpatient basis for most people. Everything from detoxification to continued care and recovery maintenance. If traditional treatment has not worked, we recommend going to private practitioners and smaller clinics to receive more intense and individualized care.
Call (844) HARMRDX to set up an initial assessment to put together the most effective treatment team for you. Or download our app "HARMREDUX" from the app store for iPhone or android to see a list of providers.
Each drug enacts upon different receptors in the brain, soothing whatever emotional pain a person is going through. The brain is an organ, just like the heart, lungs, etc. If there was anything wrong with other life sustaining organs a person would go see a medical doctor immediately. If the treatment the doc is prescribing is not working, they will regularly adjusts the treatment until it works. Whether it be trying different combinations of medications or sometimes surgical procedures are warranted. Some treatments may work initially and then stop, and adjustments are necessary. There are as many ways to counsel and intervene with co-occurring addictive and mental health disorders as there are medications for other mental and physical ailments. A knowledgeable professional will adjust to the individual as they go.
This is what integrative treatment needs to look like:
Holistic - In this case "holistic" means treating the whole person simultaneously (biopsychosocial-spiritual), while meeting your personal needs as they arise. There is no order to treatment. We will help you work through whatever issue is protruding, even though abstaining from substance use may not be #1 on your list. Better is Better, and getting help to achieve your goals in the order you feel is necessary will eventually improve your quality of life, reducing the need to use drugs. This is only done through experiencing your stressors in "real time" and adjusting your coping if a similar situation or emotional trigger occurs.
Multidisciplinary - Drawing from a range of professional perspectives. This is your treatment team, consisting of all the treatment services you need. Working with private practitioners is working in depth with specialists, who know how to adjust your treatment based on what you report. There are nearly as many styles of therapy to treat each disorder as there are medications for each psychological disorder. Just like meds, that can stop working and requiring adjustment, talk therapy works the same way, and has a comparable effect to treat addiction and other mental health ailments.
Comprehensive - Meaning, placing treatment in the larger context of scientific knowledge about its nature. The focus is to address the full spectrum of treatment as it befits the management of a complex and often chronic condition.
Collaborative - Is vital when treating addiction. It is important to sign releases so your private treatment team can talk openly about how to work together to help you get better.
Evidence Based - Public and professional opinions regarding substance use disorders have often proved to be inaccurate through well designed scientific research. A good treatment provider is able to differentiate opinion from science.
What Integrative Treatment Looks Like
Having someone you care about stuck in the vicious cycle of addiction can be very difficult. Feelings of helplessness could arise, and the stress of witnessing your loved one destroying their life and you not being able to just make them stop will certainly affect your quality-of-life. The good news is that you have options about what to do to help yourself and the addicted person in your life.
Finding addiction treatment and recovery support programs can be deceiving, and when there is an urgency, the first thing someone does is go online and search for treatment programs without knowing who is legit and who is in it to turn a quick profit. By legit I don't mean seeking out anyone who is licensed, there is a little more to it. Even among licensed programs, one needs to know which ones will provide quality treatment that's individualized. Programs are opening and shutting down all the time. During our family training sessions, you will be educated on how to intervene and who can help.
We offer free family training program to help educate you about tools that you can apply to get help for your loved one while taking care of yourself. Learn about resources that are available to your family. Learn about what to look for in addiction treatment programs and what questions to ask. If the situation arises that the addicted member refuses to get help, or is in denial about the severity of their substance use disorder you will need the help of a professional who is skilled at intervening with the addicted and their family. However, hiring an interventionist is very costly and may or may not work. So, if finances are scarce we will educate you about what methods you can use to help someone agree to get help.
Self-care may be your only option at the moment.
If you hit a dead end while trying, the only thing you can do in the moment is take care of yourself, whether or not the addicted individual is still living with you. Self care is crucial when you have to deal with someone who is addicted. You cannot help them if you are suffering yourself because of their actions. The burden is put on you to maintain and take care of personal and family responsibilities on your own. Anger and resentment towards the person who is causing all this suffering begins to build, then reluctantly you give up on them and feel like you have no choice but to remove the person causing you pain, or remove yourself from the situation. Even though this may help, but if someone close to you continues to suffer and you have no idea what is going on with them after they are removed from your life, the worrying may set in, and this too can take away from your daily functioning.