It is a good idea to explain the difference between a relapse and a lapse. A lapse is when an addicted individual uses their substance of choice, almost immediately shares that information with loved ones or healthcare professionals and continues to participate in their recovery, often attempting to learn as much as possible from the experience. Relapse refers to a recurrence of the psychological elements of full-blown addiction. Hiding or lying about drug use and separation from loved ones or healthcare professionals that persists for a longer period are characteristics of relapse. It’s worth noting that it is not binary, how much time after a lapse can pass before the lack of re-engaging with the recovery process indicates it is a relapse is not clear. Some lapses carry elements of relapse however all relapses start with a lapse.
The NIDA does not subscribe to the idea that there is a difference between a lapse and a relapse and therefore categorizes all lapses as relapse regardless of duration. This is in alignment with the disease model of addiction however is a view that does not serve the transformation and growth of an addicted individual. It categorizes all forms of lapse with the same seriousness and degree of severity. Credit where credit is due, the closest I have experienced to the current treatment model acting with sensitivity and wisdom to this very important distinction has been by the judges presiding over drug court hearings. In most cases, a judge will take the duration and severity of a lapse into very serious consideration when considering punitive measures against the individual. Not to say drug addiction counselors don’t do the same to some degree but the disproportionate power between an addict and a judge makes their sensitivity far more powerful than a drug counselor.
Continuing to define all lapses as a full-blown relapse promotes the sustaining of the “Recovery Bubble” and constructs a belief in the “Sobriety Pedestal”. These are two phenomena that most who have been through treatment and recovery, successfully or unsuccessfully, are familiar with. The “Sobriety Pedestal”, unquestioningly adopted by most 12-step programs, is exactly what it sounds like, putting sobriety on a pedestal. Coins or chips are often offered those in recovery to mark a certain amount of time sober and can serve as an indicator of health for many in recovery. When a lapse or relapse occurs in a person who has 5 years sober there is an immense sense of loss and regret that often overshadows the importance of learning from this lapse. The transformational work that enabled them to reach 5 years sober is thrown out the window in their view, and they must start all over. This is extremely disempowering and can severely exasperate the intensity and duration of the lapse or relapse.
The “Recovery Bubble” refers to the promotion among those in recovery to stay exclusively within recovery or sober communities. This makes perfect sense for those who are particularly prone to lapse or relapse, those who are recently entering or re-entering recovery. The main problem with the “Recovery Bubble” comes in the long-term. Those in recovery are taught that they are not like other people and cannot re-integrate into communities where substance use is present, ever. This leaves the individual incredibly vulnerable to their external circumstance in the long run. If the only thing keeping someone in recovery and from relapsing back into the throes of their addiction is rigidly controlling their external circumstance then the success of their recovery long-term will most likely come down to luck. I don’t by any means suggest that those who have experienced addiction should use their substance of choice again as some sort of test to see if they have matured beyond their addiction. However, leaving triggers for use present in the world at large unaddressed, coupled with conditioning those in recovery to believe they can never fully re-integrate with “normies” maintains a very short-sighted view of addiction recovery.
Ultimately, most of our readily available, insurance covered methods of treatment for drug addiction share this same short-sighted view. Given the intuitive knowledge of the type of commitment it takes to support individual growth, healing, and transformation, the short-sighted view of the current treatment model seems to be a case of the ‘Shirky Principle’ in action. The ‘Shirky Principle’ states, “Institutions will try to preserve the problem to which they are the solution”. Though I doubt there is a group of powerful individuals consciously deciding that treatment for drug addiction should be sub-par to generate more profits, I do believe that in part, under our criminal view of drug addiction, those in power can consistently overlook the importance of offering a long-term continuum of care for addiction recovery.
The truth is, even without insurance paying a dime, having a recovery coach provide a long-term continuum of care for addiction recovery is not unaffordable. Signing on for 12 months of support and accountability for addiction recovery costs between $6,500-$9,000. Some inpatient rehabs may cost around $6,000 for a 30-day program. Well-known centers often cost $20,000 for a 30-day program. For those requiring 60-90 day programs, the total average costs could range anywhere from $12,000-$60,000. That’s $6,000-$60,000 for a 40%-60% chance of having a successful treatment outcome. These programs do not offer follow-up care or long-term accountability and not providing a continuum of care for addiction recovery. If you lapse or relapse after going through these programs you do not get access to a long-term continuum of care provider, nor can you return for more treatment for free or a discounted rate. They will take no responsibility for the lack of success in treating the addicted individual. Remember, they have already hurried you along with your transformation before you leave the facility they make sure you know your treatment outcome is entirely dependent on you. They did, after all, get you to a state of sobriety for some time. Isn’t that all the healing that an addicted individual needs? If someone uses after getting sober it must mean they truly want to stay addicted. Wrong. These facilities help you get sober, maybe for the first time in decades. They do not, however, help you stay sober. Treatment, in general, does not help you stay sober. That unspeakably massive responsibility falls on the individual and their loved ones if they are fortunate enough to have the support.
12-step programs, SMART Recovery, Refuge Recovery or any number of sober communities can help bear some of the weight of this immense responsibility to stay sober. Even those who are religiously attending meetings experience lapses and relapses at an incredibly high rate, so we know that these support communities are a piece of the puzzle but not the entire solution. The missing piece is a skilled and experienced professional who is committed to bridging the gap between addiction treatment and the individual. Recovery coaches work with clients to create and stay accountable for a recovery plan which is supported by the individual’s self-defined goals. The current model of addiction treatment removes from the individual the value of their journey to lasting recovery. Recovery Coaching supports the momentum towards lasting recovery by centering the recovery process on the individual’s unique personal experience with their addiction rather than de-emphasizing the value of one’s own experience. To mature beyond addiction, one has to look deeply and thoroughly into the internal and external factors that led them to their addiction in the first place. The bottom line is that not only does the current addiction treatment model does not offer support in truly growing beyond addiction, but they also seem to disregard it’s importance altogether, so there is a need for Continuum Of Care For Addiction Recovery.