Many recovering drug addicts (myself included) have a recurring nightmare: You wake up one morning and suddenly all of the work you have put into staying sober is gone. Maybe you're returning to prescription medications; perhaps it is fentanyl, or an addiction as ancient as alcoholism. Regardless, the underlying fear expressed in that bad dream is that one day a person who has remained sober will again start abusing drugs. If that happens, does that mean you should give up hope about remaining in recovery?
Experts agree: Absolutely not. Indeed, a "lapse" may not even mean that you have "relapsed."
"If a person is abstaining from alcohol, and they're choosing to abstain, and they have an episode where they drink some amount, that's usually considered a 'lapse.'"
"We tend to think about lapses and then relapses," explained Dr. Kenneth E. Leonard, the director of the University of Buffalo's Clinical and Research Institute on Addictions. As Leonard noted to Salon, there is a crucial difference between lapsing and relapsing. A person can engage in addictive behavior on one occasion and, if they make sure it never happens again, avoid serious long-term damage.
"If a person is abstaining from alcohol, and they're choosing to abstain, and they have an episode where they drink some amount, that's usually considered a 'lapse,'" Leonard told Salon. "Then the key is preventing that from turning into a 'relapse,' which is where they return to their previous levels of excessive drinking. You can apply that same kind of concept to other substances as well."
Distinguishing between "lapses" and "relapses" matters, according to Leonard, because it puts the phenomenon of breaking sobriety into a healthier context. While lapsing should never be taken lightly, it is common, and therefore a recovering addict should not feel ashamed. Most recovering addicts will lapse at one point or another. If they emotionally batter themselves over "failing" and decide to give up altogether, they will have made a terrible mistake — and will have held themselves to an unrealistically high standard.
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"My advice would be to try again!" Leonard said when asked about a hypothetical lapsing addict. "Most people who achieve stable recovery have some number of lapses. They make a number of serious attempts, and we know that some for some people that can be two or three, but it could be as many as five or six or ten. People who get back into a recovery mode can go on to achieve, valuable outcomes in their lives."
"If a person is abstaining from alcohol, and they're choosing to abstain, and they have an episode where they drink some amount, that's usually considered a 'lapse.' Then the key is preventing that from turning into a 'relapse,' which is where they return to their previous levels of excessive drinking.
Yet why does the lapse happen in the first place? As it turns out, there are complex neurochemical reasons underlying why addicts may return to their substance of choice.
"One thing is clear: Addictions set up long-term changes in the brain that promote drug-seeking behavior," explains Dr. Steve Maren, who studies how highly valence memories (whether for aversive stimuli or drugs) are suppressed, and how individuals relapse, at Texas A & M. "There are important psychological variables that interact with those brain changes. The context in which drugs are taken, and the stimuli-associated with drug taking, are key variables in the maintenance of drug use and abuse."
When an addict decides to abstain from drug-seeking and drug-use, the changes circuits in their brain that supported the addictive behavior are reactivated. This is particularly true when a recovering addict is an environment which reminds them of why they became addicted.
"The reactivation of those circuits are essentially reminders of drug-taking and that experience," Maren explained. "And so I think that's one of the major factors that can drive relapse, the sort of memories that are associated with drug-taking and that caused the drug seeking behavior to kind of reappear after it's been silent for some period of time."
Harvard University physician and addiction specialist Dr. Peter Grinspoon writes that one should view a lapse as the final step in a larger breakdown of the recovery process. If a recovering addict has fulfilling relationships and overall is satisfied with their current life, it is far less likely that they will slip back into addictive behavior. Lapsing and relapsing addicts behave as they do because there has been a larger deterioration in their life. The decision to abuse a substance is simply the final step before they hit the bottom.
"It is often said that when a person relapses, the act of taking the drug or the drink is the final manifestation of the breakdown in their recovery process," Grinspoon explains. "That is, people lose sight of — and stop practicing — the positive ways of being and interacting that have supplanted their drug use. The drug or the drink is left to fill the vacuum, and to erase the pain."
While there is no quick and easy way to snap out of a spiral that might lead to lapses, there are some techniques that can be helpful. First and foremost, see if your HALT needs are being met — that is, are you hungry, angry, lonely or tired? If there are problems in those areas of your life, try to fix those immediate physical and emotional health concerns, as addressing them early can nip a potential lapse in the bud. It also helps to exercise, as physical fitness releases endorphins in the brain, which help you feel good. There is also nothing wrong with distracting yourself with sedentary and harmless escapism like watching TV, reading a book or playing a video game. Finally you should never feel like a burden for reaching out to your support network. Recovering addicts are there for each other.