Realistic Expectations about Relapse

Addiction is a chronic disease. (For more, click on Definition of Addiction). Treatment doesn’t cure addiction, it teaches how to manage it, how to bring it into remission one day at a time. Over a period of months and years, the toxic memory of the emotional benefits of drugs — their emotional medicinal value — atrophies even if it doesn’t disappear. Recovery is a difficult process and it takes a lot longer than most people anticipate. But like most things, it gets easier with practice.

The most common unrealistic expectation is that addicts should achieve stable sobriety after a single treatment without any relapses. It happens, but it’s rare. I’ve know two or three who’ve done it. But I couldn’t. And for everyone I’ve known who succeeded the first time, there were scads more who didn’t. Almost everyone I know in recovery had at least one relapse and many have suffered multiple slips. (For more on relapse, click on Cravings, Amnesia, Relapse, Coming Back From Relapse, and Can Relapse Be A Good Thing?)

Realistic expectations of treatment start with an understanding that in a chronic disease like addiction, in which sobriety requires monumental mental and behavioral changes, relapse is normal. Most have to suffer through them to learn how to live sober.

Clearly, relapse should be avoided at all costs because it’s devastating. It puts you right back on the downward trajectory that ends eventually in death. Sometimes it’s not so eventual. Newly-sober adicts risk overdose because it’s all too easy to misjudge post-treatment tolerance. For example, two of my Aftercare buddies died from heroin overdoses the very first time they relapsed.

So relapse isn’t something anyone should play down. But, as both sober addicts and neuroscientists recognize, whether it’s diabetes, alcoholism, or any other chronic disease, relapse is to be expected. It’s often necessary to slip to induce the desperation necessary to learn how to make the life-changes demanded. Knowing that relapse is part of the disease doesn’t make it any less terrifying, but it makes one more realistic about ttreatment prospects.

The good news is that for most of the addicts I’ve known, post-treatment relapse has been cognitively different than pre-treatment “falling off the wagon.” Treatment plants seeds. It stuffs the rational mind with evidence that, once learned, is hard to extinguish. As the AA book The Twelve Steps and Twelve Traditions  puts it, “… when one alcoholic had planted in the mind of another the true nature of his malady, that person could never be the same again.” When you’ve accepted that you lose control over your drug use once you take the first drink or drug, it shifts your perspective even during a relapse. That’s why one of the most memorable things I heard at one of my first AA meetings was, “A head full of AA and a belly full of booze is a terrible place to be.”

It’s true. When you relapse you give in to the “fuck it” feeling. You get momentary relief from the drink, precisely what you’re looking for. It feels GREAT! LIKE IT WAS ALWAYS MEANT TO BE! But like a whiff of smoke in a hurricane, that feeling quickly disappears, lost with the realization you’ve fallen back into the deadly clutches of “the Disease.” You realize “fuck it” means you’re fucked.

After treatment, not all but many who’ve relapsed, myself included, find it easier to come back to their senses, overcome the shame and embarrassment of relapse, and realize relatively quickly that we have to stop again. That’s what treatment aims for. Knowing many will relapse, counselors stress that even drunk we’d know we’d backtracked, that we were out of control. Fortifying the rational mind with treatment or AA-based knowledge helps. If you live long enough to get sober again, that is. And if you can overcome the guilt and shame, something that all too often takes a long time and a lot of suffering.

Furthermore, relapse teaches an addict a great deal. It re-enforces Step 1, the loss of control. In the “pink cloud” of new sobriety, it’s common to conclude you can handle a drink or two once in a while and get away with it. But relapsers return to the depths of their disease in a shockingly brief time, just a matter of days. Having already dissected the insanity of drug use in rehab or 12-Step meetings, it’s much harder to deny it.

The most important expectation of treatment is to understand that relapse doesn’t mean treatment failed. As Dr. Alan Leshner, then the Director of the National Center on Drug Abuse, wrote, “The occasional relapse is normal, and just an indication that more treatment is needed.”1

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1. Addiction Is A Brain Disease; And it Matters, Science Magazine, October 3, 1997.


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2 Responses to “ Realistic Expectations about Relapse ”

  1. I’m a little confused on one thing regarding relapse. If someone who was received treatment in the past can recognize to a point that what he/she is doing is wrong, because of what they have learned, then how is it possible to slip to the depths of the disease in a matter of days? Or does that simply mean that in spite of being in the throes of addiction, some part of their consciousness is aware of what’s happening?

  2. The active-addict brain is out of proper balance; the motivational power of the “emotional brain,” where addiction resides, overpowers that of the “rational brain,” which considers consequences and puts the brakes on emotional impulses. Behaviorally, the overwhelming emotional need to satisfy a craving or hold withdrawal in abeyance can blot out consideration of consequences, removing the rational brake.

    With sobriety the balance between emotional and rational motivations is restored (to a point), making it easier to exercise self-control. However, with re-introduction of drugs, imbalance is resurrected. Relapsers again over-stress the emotional and under-stress the rational.

    That doesn’t mean the rational brain disappears; relapsers know at some level that they’re screwing up (at least I did). But that awareness isn’t strong enough to motivate a rational response. The opposite motivation, continuing to take drugs to avoid detox, is too just strong.

    Lucky relapsers eventually face the same despair that prompted their original decision to get sober and go back to treatment. They have a new chance. Unlucky relapsers all too often don’t, accounting for the monstrously high number deaths from overdose and other complications of addiction.

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