Why a relapse shouldn’t ruin your recovery

In mental health, it is broadly understood that people recover gradually and sometimes have setbacks.  

For example, if a person diagnosed with schizophrenia struggles with adherence to their anti-psychotic medications, mental health care providers would not say that the person has relapsed or failed. Medication adherence can be more difficult than it seems, and the side effects sometimes cause great ambivalence. 

But if the person with this diagnosis continues to push forward in recovery despite these challenges, they are rightly not labeled a failure by mental health professionals and advocates.

The same principles should apply to people who use substances and those with substance use disorders. 

People recover gradually and sometimes have setbacks.  Due to the predominance of  rigid abstinence-only attitudes in this field, however, a person not pursuing total abstinence from all substances gets labeled in many circles as being “out of recovery,” and a divergence from their goals is seen as a “relapse.”  

A person seeking something other than total abstinence, or even a person seeking but not always achieving abstinence is labeled as being “not ready for recovery.”  It is widely stated that a person receiving harm reduction-based help is only doing so “until they are ready for recovery.”

I take issue with this–as do many health care professionals working in substance use who are well-acquainted with the philosophies guiding harm reduction practices. 

Recovery in the harm reduction lexicon is often defined as any positive change. 

“Better is better,” is the way Kenneth Anderson, MA, of HAMS, a harm reduction-based support organization explains the concept. 

SAMHSA, the Substance Abuse and Mental Health Services Administration, defines recovery as “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” 

What accounts for the difference in how some people think about “relapse” between mental health and substance use then?

I think it has to do with the differences in how mental health and substance use providers are trained and acculturated. For instance–the focus on diagnostic criteria.

In mental health circles, for example, a few days of depression is not defined as a “relapse” of major depression because the DSM-5 diagnosis requires at least two weeks of a change from previous functioning. (The DSM-5 is the reference guide for classifying and diagnosing mental disorders.)

Furthermore, even if a person does experience a relapse to diagnosable major depression, the person is unlikely to be attacked for “not wanting recovery badly enough.”

On the substance use side, however, people acculturated in 12-step based thinking tend to declare one use of any substance, even one that the person does not consider a problem, as a relapse. If a person is in recovery for their meth use, but decides to take a hit off a joint, this would be considered a relapse (even if the person doesn’t have any issues using cannabis). 

This categorization is at odds with the DSM-5, which explains that a single use of a substance cannot constitute a return to a substance use disorder after a period of remission (aka “relapse”). It is only when and if the substance use leads to the presence of significant impairment in daily functioning that it would be appropriate to describe this as the resurgence of a substance use disorder.  

The implications of this are immense.

In both mental health and substance use, an inclusive and non-judgmental attitude is the key to healthy thinking and discussion about recovery. Any person who struggles and who is seeking improvement is in recovery. Each individual gets to decide how that recovery looks for them, and supporting them must be informed by autonomy and self- determination.  

Labeling someone as having a “relapse” in their recovery journey can lead to shame–the opposite of what we want someone seeking to improve their relationship to substances to feel.

September is National Recovery Month. This month, I encourage everyone to honor the diversity of approaches people take in pursuit of a better life. If you are experiencing difficulties with mental health and/or substance use, help is available. You have the right and the responsibility to find the type of help that actually helps you. If something you are trying is not working, it may not be the right approach for you. It does not make you a failure.