By Haley Kennedy, Recovery Coach – 7.2.2021 –
When someone is being treated for degenerative disc disease, and their pain returns, do medical professionals refer to the recurrence as a “relapse?” … Never.
Seldom with other medical conditions do we use the term “relapse” when the symptoms return.
So, why is it that we can’t let go of that term when someone who’s been abstinent starts using again?
One of the experts who has shared on this topic, William R. Miller, PhD, wrote, “People with diabetes who appear in the emergency room in glycemic crisis are not told that they have relapsed.” He also reflects upon how in United States disease model treatment, the term “relapse” implies very limited all-or-none thinking. Focusing on and warning people about “relapse” implies that any use is “bad” and equals loss of control – which leaves us with the inaccurate belief that either we completely abstain, or we use out of control. Although there are certainly recurrences of use, there are many shades of grey and it is not uncommon for someone who has been abstaining to return to use and then think better of it and return to abstinence. Within those grey areas I find myself with some questions. Like, how long did someone have to be abstinent in order to “qualify” for a “relapse”…? Is use on a single occasion the same as a relapse…? If not, how much, or how long is required for it to constitute as one…?
For the most part, relapse came to be seen as the extended full-blown return to use over an extended period, while a “slip” is one-time or short-term use and offers an alternative to the all-or-nothing thinking because it implies there is something in between abstinence and full-blown active use.
“Lapse/relapse” language emerged during the prohibition era, and the words are historically rooted in morality and religion – not health and medicine. So, phrases like “falling off the wagon” became linked in the public mind to low moral character and viewed as “bad.” We still see some of the moral undertones in the language used in reference to substance use and recovery today, like drug-free is “clean” and active use is “dirty.” Other current religious or moralistic uses include a “lapsed Catholic” – someone who abandoned their faith, a “lapse in judgement” – deviating from acceptable social standards or “lapse into bad habits” – which speaks for itself.
“One of the problems with the traditional use of ‘relapse’ to connote any use of alcohol or other drugs is that it can set a person up for a self-fulfilling prophecy or what I call, “the now-I’ve-blown-it phenomenon.” – Anne Fletcher
Due to the negative connotation and the stigma associated with the word “relapse” there emerged this idea that if you violate your abstinence in any way, even just one incident, it constitutes a relapse. And I cannot emphasize how dangerous that is for those of us living with substance use disorder who are susceptible to that self-fulfilling prophecy mentioned above.
The language we use to talk about substance use and recovery can add to personal shame and perpetuate stigma towards people. It is time to stop using the shame-based word “relapse” for the chronic disease of addiction.
Instead of “relapse,” use “recurrence of a substance use disorder.” Instead of “one-time” or “short-term period of use,” use “episode.” Instead of saying someone relapsed after a treatment program, simply say that they resumed using or experienced a recurrence. Instead of referring to a someone as a “chronic relapser,” say they are someone who has not yet achieved stable recovery.
These alternative words and phrases are more accurate, reduce shame and encourage people to seek help and support