Relapse, Addiction & The Stages of Change
Relapse and Fear
For families with loved ones in recovery from addiction, the R-word is a very scary word. Family members typically fear relapse because they make sense of it as a disaster or failure or as evidence that their loved one is not serious about his recovery.
At SCHC, every client leaves with a plan for what to do after treatment, that they create with their counsellors and alumni support staff. Clients, themselves, report that they feel less pressure from family and jobs. They say their guilt has eased and others are not getting visibly angry with them. They feel better. Even family members typically remark on how well their loved one looks and acts.
Their plans can include what they will do every day for the weeks or months after leaving treatment, directions on what to do in various risky situations, and includes supports in their hometown that are easily accessible. Yet, in spite of this, research indicates that even in the best mainstream treatment programs, about 75% of clients will use a drug or alcohol within a year after treatment.
Based on scientific research, addiction experts view relapse as one of the 6 stages of recovery. This model of recovery is called the Stages of Change Model which includes pre-contemplation, contemplation, preparation/determination, action/willpower, maintenance, and relapse.
Stage One: Pre-contemplation
Those in the pre-contemplation stage have little interest in changing. The government offers help in the form of clean needles, safe injection sites, and so on.
Stage Two: Contemplation
Those in the contemplation stage have decided that they might get a better life by quitting the drug. Although they are “contemplating” change, they tend to be ambivalent about it.
Stage Three: Preparation
Those in the preparation stage have made a commitment to make a change. Their motivation for changing is reflected by statements such as: “I’ve got to do something about this-this is serious. Something has to change. What can I do?” In this stage, they learn what they need to do to change.
Stage Four: Action
Those in the action stage have learned what they need to do to recovery and are actively putting into practice their new knowledge and skills.
Stage Five: Maintenance
Those in the maintenance stage have been doing what they need to do to get on with their lives without the drug. They may be experimenting with new ways to live, learning new skills. They anticipate triggers and risky situations and plan for contingencies.
Stage Six: Relapse
Although many people see relapse as a failure, the Stages of Change model interprets relapse as a normal part of the recovery process. It’s not a requirement, of course, but the vast majority of people who enter recovery will relapse. The belief that someone who enters recovery for the first time will never touch a drug again is simply not reality.
In fact, many experts have pointed out that expecting your loved one never to use again is setting him up for failure because the scientific evidence shows that most will relapse. Relapse is a time for your loved one to figure out that what he is doing isn’t working.
How the Stages of Change Model Works
The stages of change are a cycle. Almost everyone needs to move through the cycle several times before they are stable in recovery. Research suggests that, on average, a person will go through the cycle between 4 and 7 times. Entering recovery does not necessarily mean attending a residential treatment program. It may be attending a community support program. It may be simply quitting without help. Although each time someone relapses the relapse is intense, they tend to be shorter and farther apart as the person cycles through the stages of change.
Reasons for Relapse
There are many reasons why those in recovery will relapse. According to SCHC research, the single greatest cause of relapse is boredom. Although we stress to our clients that they need to pursue a personally meaningful life, many still think that recovery means living with healthy-mindedness and good order. According to our best research, a client whose recovery plan is limited to eating well, exercising, seeing a counsellor, attending community support meetings, and other healthy activities will relapse in 3 to 6 months, mainly because of boredom.
Fear is another reason. Many people who suffer from addiction are uncomfortable taking personal responsibility for their lives. They recognize that in recovery others will expect them to keep their promises, show up to work on time, and do the household chores. For those who are uncomfortable with these expectations, they can relieve all this outside pressure by relapsing. They know that in active addiction, no one expects anything from them.
The belief that “bad things always happen to me” is also common for some in recovery. Even if things are going well, they can feel uneasy because their personal experience is that something or someone will screw things up. It’s inevitable. Rather than being caught off-guard, they deliberately relapse. That way, they get to choose the time and the day. It’s an odd thing, but it makes them feel more in control of their lives.
If addiction is a response to living a life that lacks personal meaning, then the solution is to live a meaningful life. Those who live personally meaningful lives without the drug have figured out how to feel alive and vital. They feel they are in control of their lives. Their actions match their values and beliefs. And they don’t worry that they’re only one drink or drug away from being plunged into active addiction. They have simply lost interest in being intoxicated. In other words, intoxication has lost its purpose, which was, of course, their doomed attempt to feel more comfortable in a life they felt was meaningless, monotonous, and boring. SCHC’s psychiatric and clinical teams advise clients after they complete treatment to focus not on staying away from the drug, but rather focus on getting a life.
The Best Way to Support your Loved One
It’s important to recognize that because each adult is the author of his life, you cannot cause another person to relapse. You can provide the best support for your loved one by asking yourself, “Is what I am doing supporting my loved one’s journey to be the author of his life?” Everyone is imperfect. Everyone makes mistakes. You and your loved one will likely trip and stumble a few times. Embrace imperfection. This isn’t a sign of failure or disaster. It’s a sign you’re human. And as always, if you need support, please reach out to us at any time.
Stages of Change model: Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change: Applications to addictive behaviors. American Psychologist, 47(9), 1102-1114.
General material on relapse prevention: Marlatt, G. A., & Donovan, D. M. (2005). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors (2nd ed.). New York: The Guilford Press.