PERSONAL VIEWS ON RECOVERY
Personal Views Page

(This page will carry from time to time the personal views of some of our members on issues which they believe are important in the recovery process. Our present policy is that these authors will remain anonymous and will be limited to members of the Washington D.C. S.M.A.R.T. Group. They do not necessarily reflect the positions either of the Washington D.C. S.M.A.R.T. Group, nor its National Headquarters. Comments are welcomed.)

50 Ways to Relapse Or 50 Ways to Recover?

Not too long ago, an interesting article on relapse appeared in a technical journal (William R. Miller, "What is a Relapse? Fifty Ways to Leave the Wagon," Supplement to Addiction, Vol. 91, December 1996, pp. S-15-27.) Many of us consider ourselves experts on this particular subject, having relapsed many times in the past. So we plunge into the arcane jargon, the charts and graphs, discussions of standard deviations and mean variables, the justification of sampling methods, etc., thinking perhaps some new insight in a subject of intense interest to us might be obtained. This piece shows that indeed it can.

The article, as with almost any intense examination of one small area of human activity, tells us that things are not as simple as we imagine. The "either-or" thinking ("binary thinking" or "dichotomous judgment," the author insists on calling it) we have about relapse is revealed as unrealistic. Not only do we find various and conflicting definitions of what constitutes a"relapse" (one drink? four drinks? four days drinking? serious lifestyle effects?), we find a wide variety of actual behaviors in the 12 months following treatment for addictive drinking. For the reader, not just relapse but the very goal of recovery itself tends to become equally fuzzy and elusive, for what is recovery but the opposite of relapse? Or is it?

The author examines these "post-treatment drinking patterns," and says that some people go back to drinking almost immediately, but some do not. Some who don't drink immediately drink later on, but some of those don't ever drink again. Some of those who do drink immediately, drink heavily and addictively, but some do not. Some of those who don't drink heavily and addictively do not do so later on, but some who don't, do so later on. And so forth. At any given point in the 12-month time line, some are not drinking, some are drinking moderately, some are drinking heavily and addictively, but the people in each category change from one point in the time line to another.

This confused soup of "post-treatment drinking patterns" is the same regardless of the treatment undergone by the people involved. You can't predict who is where in their recovery based on whether they underwent a 12-Step program, or Rational Recovery, or S.M.A.R.T., or cognitive therapy, etc. Social, economic and family circumstances might help explain who is in the survey in the first place, but they don't account for where they are after their treatments, i.e., whether they relapsed or not. And, the author points out, virtually no study factors in the use of other drugs (he includes cigarettes in this "other drug" category).

Furthermore, says the author, there is considerable question about whether many studies are classifying their subjects correctly in the first place. What constitutes a relapse?, he asks. Most 12-Step programs would say that even a single drink constitutes a relapse, but many others would not. The spectrum from not drinking at all, to drinking moderately, to drinking regularly, to drinking heavily, to drinking addictively, and the varying personal, social and psychological outcomes from those activities, makes it very difficult to decide where to draw a line that says, "from here on we have a relapse." The author also suggests that the concept of "relapse" may even be harmful, since it can become a self-fulfilling prophecy. It certainly, he says, "serves...no diagnostical purpose." Tellingly accurate, he says that the very notion of "relapse" is a subjective, value-laden one, as is indeed the concept of "recovery" itself.

What are we, always sensitive to a possible relapse given our histories, to do with all this information (which is actually nothing new to anyone who has experience with addiction)? Do we conclude that since just about any pattern of behavior, relapsing or not, appears in these studies, that therefore anything we do is "acceptable," in the sense of "expected"? Do we pick out an individual or group in the survey whose post-treatment experience is less than ideal but very similar to our own, and explain ourselves by saying, "well, everybody (or at least those people in the survey) does it"? Since definitions of relapse vary so widely, do we consider our own recovery as simply the absence of relapse as we choose to define it?

Our view is that these "logitudinal studies," as they are called (because they trace behavior along a time path), are useless to us as individuals trying to cope with our past addictive behavior except in one respect: they allow us to see clearly that there is no one goal of "recovery" for us except as we ourselves define it and then choose it. We have all our options open to us, including, unhappily, that of addiction. And there is no single pre-ordained path to our recovery, except as we ourselves choose it. We can examine and select those methods, strategies, realistic and rational thinking patterns which will allow us to achieve our self-defined goal; this is what Rational/Emotive Behavior Therapy is all about. Those who have gone before have demonstrated that almost any path is possible. There are too many variables in recovery for us to pre-designate any one particular path (which is what most programs such as AA and Jack Trimpey's more-recently-defined RR mistakenly try to tell us).

We wind up having to do all the work ourselves, which is as it should be. First, as indeed most 12-Step programs themselves insist, we need self-diagnosis. Presumably we do this when we reluctantly present ourselves to a hospital or AA or RR or MM or some other program because of the difficulties which drinking and/or drugging were causing us. We decide on our own long-term goals, a mixture of hopes, ambitions, and realism about the world in which we live, and conclude that drinking has proven a serious obstacle to achieving these. We struggle with the conclusion because we like to think that we can have both, the good life and the drinking.

Those of us that have made the judgment that abstinence would be more effective for us to achieve our goals (as opposed to Moderation Management, which seeks moderation in drinking) then choose AA, RR, SMART or something else simply because we believe it will work for us. Thus we go beyond the self-diagnosis mentioned earlier to the point of self-prescription. This is very much in line with the more modern approach in medicine generally where the patient participates actively in his own recovery, regardless of the medical problem involved.

Those of us in SMART choose it mainly because of its emphasis on self-help. And we need to remind ourselves that the choices others may make are not to be condemned because they are not the choices we would make for ourselves. Surely the studies examined force us to conclude, if nothing else, that people are different, require different solutions to their problems, and thus are entitled to different choices.

In sum, then, in looking at these relapse studies, the question is one of attitude: are we looking for ways that will help us achieve our goal of abstinence, or excuses to justify continuing addiction? Do we read these discussions of "factors in relapse" to see which we need to avoid, or are these "problems" which explain why we might drink? Do we look at "lapses," "slips," or "relapses" (which can be defined as simply departures from our own standards of behavior) as transitional states to addiction-free behavior, or as confirmation that we are unable to change our previous behavior?

In conclusion mention should be made of a further article in the same journal (by Gerard J. Connors, et. al.) confirming this point of view. In a section beginning on page S194 entitled "What Actually Predicts Relapse?" the authors note that while consistently negative emotional states seem to correlate as antecedents to relapse (but not sudden negative changes just prior to relapse), high-risk ("trigger") and stressful situations do not. The critical element, they say, is the clients' coping skills for dealing with their problems, and not mere exposure to stress and risk, that determine whether relapse occurs. "This implies a powerful message for clients: that they are not helpless victims of the environment...the key is how one responds and copes when [adversity] comes," they report. They regard this as an "optimistic" finding. It certainly is. But it is also realistic.


This is essay No. 1, issued November, 1997

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