relapse rate

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.