If someone in recovery from addiction returns to drug or alcohol use, how should we think about that?

Somewhere along the way, as drug and alcohol addiction services developed, the word relapse was used to describe a return the very behaviour that brought the person into treatment. However, in addition to being a shorthand for describing the return to that behaviour it also added some moralistic overtones and as a result we commonly see relapse as more than just a simple return to a behaviour, we also see it and treat it as bad, as the person did something wrong, the moral overtones kick in.

The word relapse sets up the assumption that recovery is abstinence from drug and/or alcohol use and a return to that behaviour or “relapse” as “back to square one”, a disaster, a giving up of all the effort previously invested, a loss of all the progress made so far. I don’t think the term ‘relapse’ is helpful or accurate and maybe we should stop using it and use more accurate language instead.

Most diagnostic tools define addiction as a chronic condition and yet I have seen treatment programmes and services, who on the one hand willingly accept a person who is seeking treatment using a diagnostic measure, reject and punish that same person for a return to that behaviour.

When I was in treatment, many years ago, I planned and used drugs on a trip out at approx. 9-months in. I told a peer who then encouraged me to go and let the powers that be know what I’d done. The consequence was a restart on the programme which I took willingly as the alternative was to leave which would have been potentially devastating.
I think when people in treatment or in recovery return to a behaviour that is problematic e.g., using drugs or alcohol, excessive shopping, promiscuity, gambling etc, its often an indication that something else is up, and the person is seeking relief in the form engaging in that behaviour. It’s a learning opportunity and a potential treatment / recovery milestone. It’s not a time for judgement and punishment, although there may have to be some consequences, and the less manufactured the consequences the better.

The return to an old behaviour also doesn’t mean the person has lost all the previous gains they have made either. I was speaking to a friend and colleague last night, Chris Robin, and he had a great take on this subject. He used the analogy of a football player who gets injured and as a result can’t play in his allotted position, I think he mentioned Yaya Touré who had great speed and played as a winger. After the injury he moved from the wing, where his speed was a great asset, to a more defensive and middle of the field position, where his football brain and experience was a great asset and speed was less of an issue.
People who return to a previous habit don’t lose everything, they gain experience and knowledge and if treated with care and compassion can process what has happened and why, and these can become teachable moments in their recovery journey.

Treatment services can also benefit from walking alongside and supporting them and can make their programmes and services more effective. Rather than seeing addiction treatment or recovery as an event it’s better characterised as a continuum with addiction at one end and recovery at the other. We should also see the journey from one to the other as non-linear, it’s more complicated than that and services can benefit from understanding and adapting to that.

Whatever term we use we should try and keep it accurate and descriptive and free from judgement and any moralistic elements as judgment and moralising isn’t helpful. What we want to do is get back on track as soon as possible.