The 6th Stage or Change; Relapse and Stigma

Relapse & Stigma

Written by and for people with Lived Experience - Port Alberni Community Action Team - Families Helping Families

Today’s Learning Moment – 07 26 21 Issue: The 6th Stage or Change; Relapse and Stigma

Relapse can become a vicious cycle of a return to default coping skills, often triggered by an event, an emotion or a thought that is either distressing or even celebratory.  It is the nervous system’s default mode when excited one way or the other and when other options are not entrenched in daily habit, routine and belief systems.  The main triggers fall under trauma, and I will add behaviours and events from the environment related to stigma.

Boy, that’s a suitcase to unpack!  And I thought this was going to be quick and easy.

  There are many definitions of relapse available from many different perspectives.  This definition sort of spilled out as I was writing and is a combination of official definitions, my learning and experience as a mental health and substance use clinician (retired), and my lived experience. 

I was going to start with the fact that relapse and slips, often interchangeable terms, are a part of the journey of recovery from substance use disorder.  I view slips as occasional trips along the way and relapse as the return of old coping patterns. 

So notice I said the return of old coping patterns.  I did not say the return of substance use.  Remember that substance use is a form of coping that develops into its own disorder if misused long enough.  A slip with substances can indicate that other things are happening in your loved one's life.  When noticed and addressed – calmly and factually – it can turn into an opportunity for learning.  Many people will take the slip and grow from it, especially when their supports understand what it is and that it is a natural part of learning growing and healing.

Many people let it get away from them.  That’s when a slip becomes a relapse, a full-blown return to default coping patterns. This happens when a slip is viewed by the person who uses and/or by their supports as a problem, disaster, catastrophe, a shortcoming, personal failure, a betrayal, weakness, hopelessness, criminal, a liar, a bad father, a bad husband, a useless nothing…..and so on.  These are terms that just spewed out as I was writing them and I’ll tell you where they come from. 

They come from me.  They come from how I felt when I was going through the early stages of my journey.  When I used to slip and then fall back into relapse.  I felt and believed all of these things about myself at one time.  And to make a very long story short, it was far easier to fall back into my old patterns of substance use than it was to face what I thought were the truths about myself.  I didn’t know why but I knew it was easier.  I would just give up rather than face what I thought was the truth. It wasn’t until I got to the point where I was learning about myself, becoming mindful, starting to see some hope that maybe, just maybe, I’m none of those things. 

Now, add on a person close to me in my life, who believed those same things about me because I used substances.  A person that doesn’t understand, through no fault of their own, the truth of substance use and substance use disorder.  A person that has been brought up, trained, even brainwashed by sensational propaganda from governments right down to the kitchen table.  Now that person close to me, to be supportive with what they know, and the best intentions use those beliefs to attempt to help me change.  Go back and read them again.  How are any of those beliefs supposed to inspire or motivate any kind of change?  Why didn’t I change when the person dug into me, pointed their finger at me?  Labelled me, put me in the “addict” box?  Why did I go back to my old coping?

Well, remember back when I wrote about stage 4, the Action stage of change?  I included an exercise that required us to write down our faults, and then counter them with positive statements, but write the positive statements with our non-dominant hands.  (If you haven’t read stage 4 and completed the exercise I encourage you to do that now).  Remember how awkward, uncomfortable, disappointing, fearful of failure, that we can’t do it, that we want to use our dominant hand, it’s so tempting to go back, it’s almost impossible? – Almost – but it was possible. And we did it. I have never seen anyone not be able to do it.  I even had someone with a cast on their hand who completed the exercise.  Some did return to their dominant hands briefly and came back. Many needed a little encouragement. Imagine that.

Well, to make another long complicated story short (I’m not sure I’m good at doing that yet), our brains have developed neural pathways that are believed to be permanent.  Some believe this is brain damage or brain disorder.  Others are collecting very convincing evidence that this is a natural state of development of the brain and that through something called neuroplasticity, we can create new pathways.  We call it rewiring.  But it doesn’t happen suddenly.  And it is easy, to return to the “default” pathways when the new pathways are not yet fully developed.  This is all part of a much bigger story that I won’t go into with this article.  But suffice it to say, this is not about being a bad person or a criminal.

Substance use disorder does not change or heal with the current belief systems that we have been taught over the years, from childhood, and think are valid and true.  Many small nuggets of truth have been mutated into misguided distortions.

This is in part how stigma has developed in our collective social consciousness based on over a century of demonization of something that is a social, physical and mental health concern.  We have been told that drugs make us violent, that they are addictive the first time, that they are criminal, that they cause interracial relationships (gasp), and relationships with musicians (don’t tell my wife) (seriously see Harry Anslinger 1930).  We’ve been told (and we do see) that they cause so much pain and suffering and that the only way to stop this madness is to criminalize the use of some substances and imprison people who are otherwise struggling with some of these social physical and mental health issues. This is supposed to stop people from using drugs.

How does that even make sense?  How’s that working so far?  Has drug use decreased? Has crime decreased? Has social mental and physical health increased?  Do I really need to answer that?

Yes, substance use disorder develops in a very complicated way as I hope has been demonstrated to some degree here.  It usually occurs when substance use becomes more than a recreational pastime (think alcohol, pot, hallucinogens, cocaine, stimulants) and develops into a default coping pattern in a person’s everyday life.  But one of the most important contributors to the problems experienced by people who use drugs has been the demonization and criminalization of substance use in today’s civilization.  In other words, stigma.

I wrote a piece on criminalizing sugar.  It demonstrates what would happen to people if we did such a thing.  The impact on everyone, especially diabetics and others with illnesses would be devastating.  Not only due to the legal implications, but also because of the belief systems that would develop from that and dig into the very fabric, the kitchen table talk, that we participate in every day. We would actually all become criminals, wouldn’t we.  Sugar would become tainted with other toxic substances for profit purposes by the black market.  And we would all be weak, liars, betrayers, thieves, hopeless and so on.

I don’t think I need to milk the metaphors anymore.  I hope that the point is clear.  Relapse is a natural part of brain functioning.  The “antidote” is creating new default pathways through daily routine changes and a new routine and coping development.  This is what “treatment” should be focused on.  It is not the moral and personal failings of will or even the helplessness that we have placed on it.  It is treatable, it is preventable, but the only reason it has become a demon in our society is that we have supported the beliefs and stigma around it. 

The current beliefs we have about substance use are one of the underlying causes of substance use and ongoing slips and relapse throughout the stages of change.  What do you do?  Keep focused on new routines.  Use slips as learning opportunities.  If you find yourself thinking and feeling you’ve been betrayed that’s understandable.  But know that you have not and these thoughts and feelings are part of a much bigger social lie that has been tattooed into our social consciousness.  It’s time to cover up that tattoo, get a new one and discover the opportunity, possibility and hope that recovery will bring when not tainted by the poison of stigma.

Regardless, always be prepared for slips, falls, setbacks and some disappointment.  Remember that these are not failures, they are rather, opportunities to learn more for stronger growth, not just for your loved one but for you as well.

All our past articles can be found here: https://ptalbcat.blogspot.com/
The link to this specific article is: https://ptalbcat.blogspot.com/2021/07/the-6th-stage-or-change-relapse-and.html

SHARING is best done by copying and pasting these links everywhere you want:

Author: Ben Goerner— Ben is a retired counsellor. He advocates for people with substance illness or mental illness.

Families Helping Families is an initiative of the Port Alberni Community Action Team. We send out “Learning Moment” articles regularly to help folks understand substance illness. Knowledge is vital in understanding the illness of our family members. You may copy, distribute or share our articles as long as you retain the attribution. You can be added to our distribution list by dropping us a note at - albernihelp@gmail.com

Resources:

Miller, W. R., & Rollnick, S. (1991). Motivational interviewing: Preparing people to change addictive behavior. The Guilford Press.

Prochaska, J. O., & Norcross, J. C. (2001). Stages of change. Psychotherapy: Theory, Research, Practice, Training, 38(4), 443–448. https://doi.org/10.1037/0033-3204.38.4.443

https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-therapies/motivational-enhancement-therapy 

Center for Substance Abuse Treatment. Enhancing Motivation for Change in Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1999. (Treatment Improvement Protocol (TIP) Series, No. 35.) [Table], Figure 2-2: Appropriate Motivational Strategies for Each Stage of Change. Available from: https://www.ncbi.nlm.nih.gov/books/NBK64963/table/A62587/

Lewis Marc Dr, (2015) The Biology of Desire, Public Affairs Perseus Books New York

Boyd Susan et al (2016) More Harm Than Good: Drug Policy in Canada, Fernwood Publishing Nova Scotia.

Mate Gabor M.D., (2008) In the Realm of Hungry Ghosts, Vintage Canada Toronto.

Alexander Bruce Dr, (2008) The Globalization of Addiction, Oxford University Press

https://bensharmonics.com/the-prohibition-of-sugar/