Why labeling a decision return to old behaviors as “Relapse” is counterproductive to the behavior change process.
The standard definition of “relapse” is a return to an active disease state after a period of remission, sometimes referred to as recovery. The problem with all these terms when they are used in the context of addictions is that they are being used to describe a condition that is primarily a very ingrained habit as if it was an incurable disease. For the sake of this discussion, I am defining an addiction (including an alcohol one) as a mal-adaptive behavior chosen by individuals to cope with emotional pain that, through both repeated usage and the initially pleasurable aspects of the behavior, becomes an ingrained habit. When those behaviors utilize substances that are physically addictive and painful to stop fit makes that habit even more ingrained.
The process of becoming addicted starts with personal choice. There was some sort of unfulfilled need within individuals that seemed to be satisfied by their initial experimentation with the behavior. At that point, there was a choice to continue that behavior because it was producing the desired relief from their internal pains. With any behavior, repeated use will eventually signal to the Inner Mind (subconscious) that the behavior is normal and natural so the Inner Mind will adopt it as the standard operating procedure and will produce that behavior on cue. At that point, the behavior is now a habit. The longer that habit is practiced, the more ingrained it will become. What started out as a choice has now become an automatic process and will stay that way until another choice to the contrary is made.
Because some of these habitual behaviors involve substances that are physically addictive with real withdrawal symptoms associated with stopping their usage, this whole process of behavior change has been labeled by the medical world as a disease and all the disease metaphors have been applied to it. There are actually two things going on here, a physical addiction and an ingrained habit that have been conflated into one disease concept. Because of that the focus becomes treating a disease rather than of changing a habit. Also, by using disease metaphors, especially the “incurable” ones, it is a set up for returning to the old behavior. The meta-message for the term “relapse” is that going back to old behaviors is a normal and natural part of the cycles of recovery That might be true for cancer, but with the changing of ingrained habits, it is just a convenient excuse for choosing to return to a former behavior.
Because I believe that what is usually labeled as failure is really just feedback that something was missing in a previous attempt, so some new learning needs to be learned. By labeling a decision to pick up an old habit again as relapsing, instead of as a conscious decision to abandon a responsible course of action for an acknowledged poor one, is only useful to eliminate self-blame and shame of making a lousy decision. The problem is it is a set up for future repeats of those lousy decisions. There is no shame in owning having made a poor choice, learning how to do things better, and choosing to do those things, no matter what.
Looking at this entire process from a habit change point of view
- Through progressive, negative experiences that can be associated with what was here-to-fore pleasurable activities, a realization emerges that continued practice of the behavior is producing an unmanageable life and that something needs to change, though how to do that might be a mystery.
- They made a choice to stop the behavior and seek a better solution and as long as there is a hope that that will happen, they will stay stopped. This is actually a very powerful choice because normally the Outer Mind just carries out the automatic programming of the Inner Mind. When that programming is producing nothing but continued grief, the Outer Mind overrides that programming and stops the behavior.
- As they learn new and more effective ways of dealing with those inner hurts and as the time since the last practice of the old behavior increases, the Inner Mind starts to get the message that these new behaviors are the normal and natural thing to do and that becomes the new ingrained habit.
- So what explains the process of returning to the old behavior?
- They get a stray thought of “wouldn’t it be nice to do……….”
- They choose to ignore all their past history and their Inner Voice that knows and tells them that this is a foolish move. Part of this choice might be that they have not gotten enough good feelings out of this new behavior change process fast enough to satisfy their need for relief, so they give up prematurely.
- They choose to continue through all the precursor steps that eventually result in doing the old behavior again.
- They choose to use. To excuse this choice by labeling it as a relapse, as if some evil disease grabbed them and caused them to do things they didn’t want to do, is a less than useful description of this process. It fails to recognize the ability to choose one’s behaviors. It totally ignores that God gave us the powerful ability to learn from past experiences and to choose to do things differently. That is the process of becoming a responsible adult
- The final prevention step would be to explore what added change in thinking or behaviors might be needed to ensure that any possible cause for reverting to old behaviors would be eliminated. With the root cause of all addictions being low or no self-esteem/love, the chances are that redoubling the efforts to build a great self-evaluation of one’s being, ie, self-esteem/love, would be the best solution.
A very important takeaway is that people will gravitate towards happiness and away from pain. Most behavioral choice is driven by that principle. When people make the choice to stop their destructive habits they are doing so in a quest for a new happiness. The “attraction” reference in the AA Traditions is all about selling new people on eventual happiness. The laughter and success stories in the meeting are the best demonstration of that happiness. The problem is that if newer people do not quickly experience those feelings in themselves, the pull to disregard the bad times and chase the temporary happiness of their former behavior can drive them to once again choose to relive their past. For all people new to this process, it is a race against time to ensure that they get to the point where their new great feelings will override any stray “wouldn’t it be nice…” thoughts. In early AA, there was a push to do all 12 Steps in the first couple of months. I think they had it right. Added to that, of course, the enhancing of their self-esteem/love will make this a totally winning process.
© 2019, rev. 2020, Jason Wittman, MPS, CATC-IV, LAADC
[Permission to reproduce this article is granted as long as this notice and the "About the Author and the copyright information is included.] *About The Author* Jason Wittman received both his B.S. degree in business management and his Master of Professional Studies in Counseling Psychology from Cornell University in Ithaca, New York. He is a Certified, Level IV, Addictions Counselor ( CAADE #155970-IV ) a Licensed Advanced Alcohol & Drug Counselor (LR01700815) and an Internationally Certified Clinical Supervisor. He is also a Certified Hypnotherapist and a Certified Practitioner of Neuro-Linguistic Programming. Jason has had a private practice as a Counselor and Coach since the middle 1980s. Currently, his practice, http://Stage2Recovery.com focuses on assisting business and professional clients, who are recovering from alcoholism and addictions to work and live at their exquisite best. He is a recognized expert in teaching and guiding his clients through the "getting-on-living" stuff including enhancing their self-esteem/love that only emerge as issues after the focus is no longer on figuring out how to stay clean and sober. He can be contacted at http://Stage2Recovery.com, email@example.com or 213-804-4408