I. Definition of Relapse

A. Relapse is not a single event (i.e. returning to abuse), rather it is a process. Gorski and Miller state: "Relapse is not a conscious choice, but the end result of an unconscious but progressive, sequence of warning signals."

II. Analysis of Events Preceding Relapse.

A. Examination of any relapse situation usually demonstrates that there were "mini-decisions" made along the way that lead to the abuse.

1. In one example, the individual put herself in a high risk situation (i.e. going to a bar or party with some "using" friends).

2. At the time, there may be a realization of entering a high risk situation, but there is denial with subsequent compromised judgment in fully assessing the capability of handling the situation.

 

3. There is usually lack of honest sharing with friends in the high risk situation about the disorder and recovery and the risks in the present situation.

B. Review of research (Marlatt) reveals that there are general categories of events that lead to relapse.

1. Personal interaction with disturbances in an emotional relationship.

2. Work events, involving a change in the person's work life.

3. Events involving a change in the health in the patient or in a member of the patient's family.

4. Events involving a change or residence.

5. Negative emotional states: frustration, anger, boredom, uselessness, poor impulse control.

 

6. Social pressures.

C. Marlatt describes the conditions necessary for a "full blown" relapse.

1. The abstinent alcoholic/drug abuser feels "in control" until he/she encounters a high-risk situation that challenges his perception of control.

 

2. The individual does not have adequate coping skills or does not use the coping skills possessed.

3. Alcohol - drugs are viewed as positive methods to relieve pain or bring pleasure and they are readily available.

4. Alcohol drug use is begun.

5. The presence of guilt about having broken abstinence or feelings of personal weakness and failure increase the possibility of continued abuse.

 

III. Expected Benefits of Use.

A. Addicts faced with a high risk situation frequently glamorize engaging in abuse.

B. There may be euphoric recall of past events and sensations related to abusing.

C. There is always some expected benefit to using emotional physical, social,

D. Denial clouds the pain of abuse.

IV. Definition of a SLIP

A. A slip is the very first instance of using, however, it may even occur before actually using/abusing. In fact, it may actually occur when the substance is procured for use. It is much more difficult to stop when the thought of use has been acted out by procuring the substance.

B. A slip is usually accompanied by all or none thinking. For example, "I might as well keep using â€" I've blown it anyway." Or, "I will use it up and get it out of the way."

1. The person perceives the thought of use or actual use as total failure and engages in abuse.

 

C. Feelings of guilt and self-loathing precipitate the use. For example, "I have spent my paycheck on this stuff, what is the use? I am weak, I deserve to be punished."

D. Conflicts about the self further precipitate a slip. The person may have perceived her/himself as recovered (cured) and yet desires to use the substance. This conflict is often expressed as, "Well, I guess I am hopeless. I am just a hopeless addict. If I were well, I wouldn't want it."

V. Prevention of Relapse.

A. The best prevention of relapse is to be aware of the relapse process and maintain active involvement in recovery programs.

B. An individual, workable recovery plan is determined while in treatment.

C. A recovery plan cannot pre-determine all high risk situations. However, awareness of potentially risky situations, self-awareness and an identified plan can reduce the risk of relapse.