In this blog post about what it means to slip in recovery, we will define terms (recovery, relapse, and slip). Then we will look at what a slip in recovery means, and consider some examples. And we’ll conclude with suggestions on how to move forward if we have a slip in recovery.
Defining Terms
What is “recovery”?
We’ll begin by saying “recovery” can be defined in many ways. And it’s been given various definitions over the years. These definitions have come from theorists, academics, researchers, public health officials, SAMHSA, and more.
The Betty Ford Consensus Panel
One definition of recovery is from the Betty Ford Consensus Panel that convened to define recovery. They said that recovery is a “voluntarily maintained lifestyle characterized by sobriety, personal health, and citizenship”. The word “citizenship” in that context refers to getting back into one’s life, family, and community as a functioning member – in a routine way – however an individual chooses to be and do.
Terry Gorski
Terry Gorski, a life-long addiction clinician, noted that you’re in a position to begin to manage your own progress once you realize (1) you’re using due to using (as opposed to any other so-called “real” reason); (2) you can’t control it now; and (3) you have to do what everyone else has to do to get better. Early on in the process that means keeping the illness at bay (disease management). And later the process shifts and becomes focused mostly on managing one’s continued well-being (recovery management). In this trajectory of improvement, recovery definitely has typical stages.
What is “relapse”?
Terry Gorski
So, what is “relapse”? Gorski calls relapse a process of (1) the person’s recovery gradually deteriorating, with (2) a simultaneous re-activation of their addiction illness. This process can include re-emergence of the symptoms of co-occurring mental health problems, and problematic personality factors. The relapse process can start subtly, and slowly build over time.
Alan Marlatt
Another very well-known life-long addiction clinician and researcher, Alan Marlatt, broke down differences in returning to use. He used the term lapse to mean a small slip. He used the term prolapse to mean a small slip leading to improved recovery. And the word relapse to mean a return to the full illness with a more severe and prolonged return to drinking or using.
What is a “slip” in recovery?
Definition of a “slip”
And so, a “slip” is commonly known to be a very limited return to use. It’s not prolonged, either. It’s not a full relapse.
Consider Gorski’s way of defining relapse (a process of deterioration that doesn’t have to include returning to drinking or using). And now add Marlatt’s way of understanding a “lapse”. Combining the two might help a “slip” come into a fuller view. In recovery a “slip” definitely signals some problems with recovery and problems with the illness were happening before the slip occurred. But both Gorski and Marlatt would emphasize it’s how you respond and what you do about the slip that’s the most important.
When you have a slip in recovery
In general, the long-standing recovery literature and wisdom (such as from AA and NA), researchers, academics, and clinicians alike would tend to agree: tell on it to your closest support people.
Telling on our illness has been called the central skill of recovery.
My illness is not “me”. At least it’s not the total “me”. There’s more to “me” than my illness.
And so, as our recovery declines, we contact our support people who know us the best and support us the best, and tell on our illness. Then, as our illness wakes up and becomes active, we tell on it.
And if we slip, we tell on it. We tell on it before it happens, when it happens, and after it happens. We tell on it.
Does relapse always mean return to use?
Does getting into a relapse dynamic always end in returning to using? Not necessarily.
Is relapsing always a part of one’s recovery pathway? Not necessarily.
Getting into the relapse process can end in a slip, or a full relapse, but it doesn’t have to.
Population-sized statistics show roughly 2.5 recovery attempts on average happen before the average person sustains their recovery. But remember, population-sized numbers describe everyone, and don’t necessarily apply to anyone in particular. Not everyone is average, or needs to be, or has to be, average.
Does everyone relapse?
If we define relapse as Gorski does, in a way that doesn’t necessarily have to end in using, then we would say, “Everyone will relapse. They just don’t have to use over it.” And that is a giant teaching point. Nothing is perfect. And that includes all of us human beings. As we struggle, we just know it’s our disease or illness, and tell on it. And return to doing what works and the accepting of support while receiving it.
What is the “abstinence violation effect”?
In his work, Marlatt warns of the “abstinence violation effect”. This is when we violate our abstinence with a “slip” and then get discouraged, give up, and make a decision to go ahead and really use a lot – because we tell ourselves we failed.
Working a program of recovery does not need to create that kind of tension, no matter how you define “relapse”. If you are struggling, tell on it and get some support – using or not. Slip or not. Just go back to doing what works!
Two fictional examples
Let’s look at some fictional examples to help bring these points out and make them even more practical.
Example 1:
After her first full year of recovery, picking up that first-year chip, things were really getting better. Life was definitely getting easier. Old relationships were slowly getting restored. Fun was fun again. And new relationships in her home group and sponsorship circle were super helpful, super rewarding, and a great source of all kinds of support. A good routine was back and she felt trustworthy again. Like she could even start to really trust herself again. Every once in a while she seemed to be a little too busy getting with her family, her extended family, or working, or out for dinner – and had to miss a meeting. Or skip a daily reading. And she started to get less consistent on doing her spiritual connection stuff – but only really, really slowly. And when she noticed it, she would get back on track doing her daily personal program.
But over time, this pattern of decline did stay in place. And her program continued to diminish.
In that context her old personality factors started to come back. And then she started engaging in some old behaviors to help herself feel better. And arguing with others and even with herself about why all of this didn’t even matter anyway. She was fine. Staying sober, doing well, with a much improved quality of life. But the pattern ultimately continued. She would get out of the relapse dynamic for a while, but she would spiral back into it again. Over time her downward spiral would pick up steam, and her awareness of it and time back in the recovery dynamic would shorten. And the helpful impacts of recovery related activities would flatten. By the time she was in her third year of recovery her illness seemed to be in full-swing. She just hadn’t had a drink at all yet.
One day her sponsorship circle and two very close family members met with her. And spelled it all out.
Things turned around. She got back into a structured daily program, and opened herself up to accountability for her daily program. The consistency and simplicity of her daily activities, checking in with her sponsor, and doing a daily inventory provided a lot of relief. And loft. And real juice for living. Her recovery was back!
Later she realized she had relapsed – she just hadn’t used over it.
Example 2:
After he completed his residential treatment program he accepted the continuing care recommendation to enter a sober residence and get in a continuing care group therapy. Afterall, his wife was continuing her active alcoholism, and no one would take him in.
During his treatment he hadn’t had a single craving. And he didn’t know why.
But now, after a number of months in the sober residence, everything was in a healthy rhythm and life was feeling great.
One day he took himself out to a pizza place. He went to get some ice cream afterwards, and someone offered him a cigarette. Before he realized what had happened, he was dragging on the cigarette, and had already sipped from a beer outside the ball field.
“Wait! What?!? What did I do?”
He ran for the car, got in, and slammed the door shut. He called his sponsor. No answer. He called his sponsor’s sponsor. Left a message. He called his sponsor again. And an answer!
After the meeting, staying with his sponsorship family, he heard some great input that he knew would keep him on track. And it did.
Did he catch himself in a slip, feel shocked and ashamed that he had violated his abstinence, and use that as a reason to throw in the towel and go all the way with a giant relapse? No way.
Did he plan to do this so he would have a better story some day for the newcomers? No way.
Getting back to the sober residence, sharing everything with all the house members and leadership, he felt so relieved. Presenting this in his continuing care group therapy was super helpful in a whole other way.
But it was a number of months before he was able to fully inventory this situation, and himself, and see the months leading up to that slip for what they were. Eventually he incorporated this understanding into his recovery program and his continuing care counseling.
Over time his daily inventorying took on an improved tone. And so did his recovery dynamic.
Slip in Recovery: Let’s review!
Early recovery
Early recovery is all about a new way of living, staying sober, an improved quality of life, and working a daily program with accountability to stay on track in the little picture. A support group, a sponsor/mentor, and continued counseling definitely help.
Eventually the fact of our improvement can be an entirely different kind of thing to try to navigate. Sometimes it’s hard to stay on track when you’re feeling better and the struggle that was such a good reminder is no longer there like it used to be.
Relapse dynamic
A relapse dynamic is a deterioration in our recovery, combined with a renewal of our active disease symptoms. This tends to take on an increased momentum over time. Sometimes it ends in using, but it doesn’t have to. Almost everyone will “relapse”, but we don’t have to use over it. Just tell on it and get back on track.
Relapse vs slip in recovery
Sometimes some people will actually have a “slip” in recovery. We don’t use over it. We don’t throw in the towel, and go all the way back out due to talking negatively to ourselves. Instead, what we do is tell on it. And get back into our recovery program, support, and accountability.
What does it mean if we “slip” in recovery? It’s hard to know for sure, but on average, for most people, it means we were in somewhat of a relapse dynamic before the slip. And we can gain a lot by slowing down and looking back at the signs and symptoms we might not have recognized or appreciated at the time.
Life is lived looking out the front windshield. But it’s understood mainly by looking out the back windshield. Just for today, we will decide to have a program and work it to the best of our ability. Even if we have a “slip” in recovery.