disease concept

How Many People Get Into Recovery And Then Relapse?

There are all sorts of numbers you hear bandied about, and none of them are really precise. Here’s why.

Relapse is difficult to measure. Obviously it occurs before we use. If we weren’t already in relapse, we wouldn’t use, would we? So if I don’t use, did I relapse or just come close?

Recovery is about making the physical, social and mental changes that take us away from our old ways of thinking and develop new ways of looking at the world that allow us to live relatively happy, healthy, sober lives. Recovery is a sliding scale, not an event, and we can move in either direction.

It is even possible to stop dead in our tracks and move in neither direction. Some of us stop using but do nothing to change. We call those folks dry drunks, and as the saying goes, “If you sober up a horse thief, all you get is a grumpy, more efficient horse thief.” If they use later on, does that count as a relapse, or were they never really in recovery?

It is reasonable to say that for people who started off making progress, relapse occurs when we begin sliding back to our old ways of thinking and behaving. Using simply makes it impossible to ignore any longer.  This brings up the obvious issue of measuring recovery. How do we do that?

Recovering people clearly move along the scale in a positive direction. Their attitudes improve, they exhibit willingness to change, and do so. They seek out positive relationships and nurture them. They become more truthful and compassionate. They recognize that false confidence is a trap, and try to remain realistic about their progress and prospects. They are willing to share what’s happening in their lives and accept feedback. They make an effort to become a part of the outside world, while retaining their connection to the recovering community. Finally, they help others to achieve the same goals.

Conversely, to the extent that they do not make those changes, or move in a negative direction along the scale of recovery, they are either not in recovery or are in relapse.

The second big issue is counting those who relapse “officially.” How do we do that? We know that a great many people who enter detox facilities do so more than once. But if they don’t return, are they still clean and sober? Did they move? Did their insurance run out? Did they get clean after going “cold turkey?” Did they die?

Many people think that the 12-step programs ought to be able to answer those questions. But how? That word “Anonymous” is a huge barrier. Who keeps the central database? Who takes and validates the surveys? How do we tell one drunk named Bill W. (a co-founder of AA) from another Bill W. who writes for Sunrise Detox? The figure we hear spoken  about in the rooms is usually in the 10 to 30% range for eventual recovery. Is it accurate? No way to tell.

A study by the National Institutes of Health (available here) is of little concrete help, but does point out other complications. How many people went into treatment facilities? How long was the treatment? How many people participated in AA or another self-help group? How many did both? How many used, but participated on a second try? How many of those who participated in groups on the first try relapsed, and how many went to treatment subsequently? You can go on and on with these combinations, and resolve little or nothing. The follow-ups on this particular study were done by phone. How many of those people simply lied out of embarrassment?

The same problem occurs with treatment facilities.  We only have contact with those who return, or who stay in touch.  We have no way of knowing what happened to the rest. A large chain of treatment centers estimates relapses at 70 to 90%, but how is that measured, and how many of those people subsequently get sober? Who knows?

The most accurate figure is probably in the 70% to 90% range. Addiction is a disease, and one of its symptoms is relapse. We can expect anything that is considered a “symptom” of a disease to occur more often than not, and for the numbers to be significant. It also gibes with our experiences in treatment and detox.

The important issue is not how many make it, but whether we, as individuals, are doing everything we can to insure that we continue to move in the right direction. One of those things is helping others to achieve sobriety. If we are doing our absolute best, then the chain builds itself, one link at a time, one day at a time.

And no one can answer that question but you.

Thoughts About Independence Day

Independence Day has a special meaning for those of us in recovery, and that's such an obvious connection that I'm not going to belabor it further. I do want to mention, however, that despite all our advantages here in the USA — and in Western civilization as a whole — there is still a lot to be done with regard to addictions of all kinds, from alcoholism to the currently popular prescription drugs.

One of the things we need to improve is the judgmental attitude of many Americans when it comes to addictive disease. This has changed for the better over the years, but we still have a long way to go educating people that addiction is a disease and that, regardless of our reasons for drinking alcohol or using other drugs initially, we did not choose to become addicts, nor to ruin our own lives or those of others.  It is perfectly natural for folks who have been impacted by the behavior of alcoholics and other addicts to resent us.  We leave trails of wreckage behind us in most cases, and there are few people in America who haven't had their lives or those of loved ones affected by addiction in some way.

But did I choose addiction? Did you?  I didn't, and I've never spoken with anyone who did. Did I choose to drink and use drugs?  Yes, but millions of people do that without problems, and I had no reason to think it would be any different for me.  Did I feel that I had no choice but to continue using alcohol and other drugs after I was addicted? Absolutely. I was convinced that I would die an addict, but that I would also die if I tried to quit using — a classic “double bind,” shrinks call it.  It's as close to a miracle as I could want, that the right combination of things happened to get me on the road to recovery.

The reality of addiction differs from what many believe. It is absolutely imperative that we get the people who consider addicts to be morally corrupt to understand the reality of the disease.

Major changes need to be made before we can approach the goal of getting the addiction epidemic under control. We need changes in the criminal justice system, so that addicts get the treatment they need instead of being incarcerated and then put back on the streets with no prospects. That's no way to keep people from using again and returning to criminal lives.  We need to throw a lot of money into research. We need sensible regulation of legal drugs that are addictive. The mish-mash of treatment protocols needs to be studied with an eye to determining best practices. And, while I am a rabid supporter of the 12-step model of recovery, we also need to develop continuing support systems for those who believe, for one reason or another, that the various fellowships are not for them.

My purpose on this Independence Day is to applaud and thank the many people in Federal, State, and even local government who are advocating for this critical health issue.  Addiction, including nicotine addiction is, by far, the primary cause of preventable death in America.  There is an overwhelming body of evidence to the effect that treatment is much cheaper than dealing with the results.  We can't afford to waste money on ineffective measures in this economy, and the waste in human lives lost and ruined is disgraceful in a country that aspires to be the best of the best.

Writers like me can only do so much.  We are preaching to the choir, since our audience is composed primarily of recovering people and addiction professionals.  I want to encourage you to get involved in these issues. Educate yourself about the politics of addiction. Advocate with your governmental representatives. Support any efforts toward dealing with this disease that you can. Spread the word, in a gentle way and by example, that we are good people. You are the only addiction educator that most people will ever meet, and are also the people best equipped to influence the actions of legislators and their advisors.

The recovery community stepped up when we needed help. Now it's our turn.

How is addiction a disease, and why does it come and go?

The Merriam-Webster Online Dictionary defines disease as “a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms.”

Let’s take a quick look at addiction based on those criteria.  First of all, it is definitely a condition of the body or one of its parts.  It creates changes in the brain and some other portions of the body that impair normal functioning and that in some cases fail to return to normal, even after the disease is arrested by abstinence.

It is manifested by signs such as abnormal behavior (often including psychosis), an unhealthy fascination with drugs, including alcohol, behavior outside accepted limits of society, and symptoms such as tolerance to the drugs’ effects, deterioration of organs and systems, and in most cases a withdrawal effect when the drugs are withheld.

The question of coming and going is almost a contradiction in terms.  The disease can be arrested.  That is, the signs and symptoms will eventually subside when the drugs are completely out of the system, but the disease is still there.  Some immediate relief is accomplished as soon as withdrawal is over — a few days for alcohol and some drugs, up to two to three weeks for some others.

During the period while the brain and other organs are recovering from exposure, there will be occasional periods of discomfort that are interspersed with times when the symptoms are slight or non-existent.  This period of post-acute withdrawal can last for months, but the progression is always toward feeling better, as long as drugs are not put back in the system.

However, “arrested” is not “cured.”  If drugs (and not just the drug of choice) are re-introduced, the changes in the brain that comprise the physical part of addiction will return quickly and the addiction will again become active.

When we combine that with an addict’s instinct to use drugs whenever he or she doesn’t feel good, it means that stress, poor health, failure to maintain a healthy frame of mind, over-response to post-acute withdrawal symptoms, and just plain depression can lead to using, and thus to the re-activation of the disease.  It is rather like diabetes, which can be arrested with exercise, diet and medication, but is still in the wings, ready to pounce, if we get sloppy about taking care of ourselves.

So you can see that alcoholism and other addictions meet the criteria of a disease (as both the American Medical Association and American Psychological Association declared more than half a century ago).  There are identifiable changes in the body, and identifiable impaired function, both physical and psychological.  Furthermore, the progression of the disease, unless arrested, is always “downhill” and almost invariably results in death, unless something else kills us first — often physical deterioration aggravated by the disease.

As regards the coming and going: barring mental illness, we either choose to relapse, or to remain abstinent.  Relapse occurs long before we pick up, and is the result of either a lack of commitment to sobriety, and/or failure to maintain our physical and emotional health and do for ourselves the things that only we can do: make use of our supports and follow “to any lengths” the suggestion of a proven program of recovery.