One of the notions regarding relapse in clinical literature has been the comparison of a lapse and a relapse:
- A lapse is traditionally defined as a sort of brief slip or very brief return to the use of alcohol or drugs that is quickly corrected, and the individual gets back on their recovery program.
- A relapse is traditionally clinically defined as the resumption of a more extended and excessive period of substance abuse after a period of improvement that includes the return of symptoms that meet the diagnostic criteria for substance use disorder (or addiction).
The difference between the two is subtle. Quite frankly, studies that have attempted to look at lapse and relapse rates across different substances have discrepant findings because the terms are often defined differently. In addition, many individuals in recovery consider a single slip as a full-blown relapse. Many organizations, such as 12-Step programs like Alcoholics Anonymous, will often point to the notion that even thinking about using alcohol again represents a potential sign of a relapse. These differing definitions make the notion of a relapse rather vague, but sticking to the above traditional notions of a slip or lapse versus a full-blown relapse is most likely the only concrete solution to defining these behaviors.
Thus, despite various definitional issues in the research, the above definitions will guide this article and discussing the issue of relapse. How one defines relapse may be an important influence on determining what happens when one suffers a lapse or slip. For instance, one interesting manifestation of a lapse is something termed the abstinence violation effect.
The Abstinence Violation Effect
Consider the following imaginary scenario:
Joe has been attempting to recover from an alcohol use disorder. His issue with drinking led to a number of personal problems, including the loss of his job, tension in his relationship with his wife (and they have separated), and legal problems stemming from a number of drinking and driving violations. He lost his license due to drinking and driving, and as a condition of his probation, he was required to attend Alcoholics Anonymous meetings. It was at these meetings that he finally decided that he was an alcoholic and that he needed to stop drinking. After six successful months of recovery, Joe believed he was well on his way to being sober for life; however, one evening, he got into a major argument with his wife regarding her relationship with another man. He was hoping that he could get back together with her, but realized that this was impossible. He became extremely despondent and went out to a local bar and had a beer. As he sat there, he realized that he had broken his vow of abstinence and then continued to drink until he became extremely intoxicated. He ended being charged with a violation of his probation. He found himself drinking heavily again despite this violation and ending up with even more difficulties. Eventually, after spending some time in jail and paying heavy fines, he returned to AA committed to “get it right this time.”
The abstinence violation effect, described by the famous substance abuse researcher Alan Marlatt, occurs when someone who was made a commitment to abstinence suffers an initial lapse that they define as a violation of their abstinence. This perceived violation results in the person making an internal explanation to explain why they drank (or used drugs) and then becoming more likely to continue drinking (or using drugs) in order to cope with their own guilt.
Instead, if the individual had considered their behavior a simple lapse as opposed to a full-blown violation of abstinence, they may have been able to use the situation to learn from their mistakes and move on. Marlatt considered the abstinence violation affect a serious risk factor for relapse that could be avoided by understanding the difference between a slip and a full-blown violation of one’s commitment to recovery. While he considered 12-Step programs and other similar approaches to recovery to be useful, he also believed that the notions of a lapse and relapse were not realistically conceived by many recovery programs.
Thus, the notion of relapse and lapse should be something that is emphasized in recovery. Individuals experiencing lapses should reevaluate their thinking and use them as learning experiences as opposed to attributing them to be total failures of abstinence. Experiencing a slip should be immediately associated as a chance to reevaluate one’s approach to recovery and change in a positive manner.
Substance use recovery programs should refrain from defining a mere slip as a total failure of abstinence. Instead, they should promote the notion that slips should be addressed immediately and that individuals can learn from them and improve. This does not mean endorsing slips, but recognizing that if they occur, something needs to be done immediately. Simple slips do not necessarily represent failures. Both slips and even full-blown relapses are often part of the recovery process.
What Drugs Are Associated with High Relapse Rates?
First, is important to understand that significant relapse rates are not associated with substance use disorders alone. The National Institute of Drug Abuse reports that overall relapse rates for substance use disorders (which are estimated to be between 40 and 60 percent) are comparable to the relapse rates for medical conditions, such as hypertension, diabetes, and asthma. The overall rate of relapse for all drugs is relatively high, as it is with these other conditions.
One of the most cited comparisons of relapse rates for substance use disorders comes from the Substance Abuse and Mental Health Services Administration’s data compiled for the years 1994-2004. These figures, which remain consistent, indicate that relapse rates for the following drugs are higher than the average relapse rate associated for all substance use disorders:
- Relapse rates for heroin use disorders were estimated to be 78.2 percent.
- Relapse rates for alcohol use disorders were estimated to be 68.4 percent.
- Relapse rates for cocaine use disorders were estimated to be 61.9 percent.
- Relapse rates for methamphetamine use disorders (crystal meth) were estimated to be 52.2 percent.
Again, it is important to remember that these figures may actually represent combined slips and formal relapses as designated by the above definitions; however, it is clear that these particular drugs of abuse are associated with particularly high rates of relapse. Prescription medication abuse is also associated with a particularly high relapse rate, similar to the rates of relapse for alcohol and heroin use disorders. However, it is important to remember that the overall rate of relapse associated with substance use disorders is high, at 40-60 percent.
What Is the Take-Home Message?
There are two important take-home messages that readers should consider:
- First, it is important to understand that there is no quick solution to recovery from a substance use disorder. Individuals with substance use disorders will often need to enter treatment several times before they finally experience sustained recovery. Lapses and relapses are part of the process of learning and recovery for many, and a person’s reaction to an initial slip may determine how serious that slip will become.
- Second, as depicted by the National Institute of Drug Abuse, relapse rates for all drugs of abuse are relatively high. Comparing the average of 40-60 percent with the above figures of drugs that are particularly associated with high relapse rates suggests that there is only minor variation in relapse associated with substance use disorders.
The important thing to consider is that the hardest drug addiction to recover from is the one that you suffer from. The actual statistics on relapse for other drugs have little to do with one’s personal recovery program.