Relapse: The Silent Killer

Let’s talk about the thing nobody in recovery wants to talk about.

Many things can be talked about freely “in the rooms” — i.e., in a 12-step meeting. You can talk about relationships. You can talk about a particular step. You can even discuss having gone to jail or rehab. But there is one topic above all others that scares the living crap out of a 12-step meeting.


There. I said it.


How much more dangerous it is when it remains unspoken.

It happens. It happens to the best of people. The most hardcore. The ones with 20 years of sobriety under their belts. Relapse. It’s the thing people in recovery fear the most out of any word in the English language. But it happens all the time.

A friend of mine recently re-entered rehab for what seems like the four billionth time. Everyone worries whether or not this time will stick — and they have a right to be concerned. Everyone — that is — except those who abandoned him after he relapsed. Even family members and friends fear relapse because the consequences are so dire. Every time an addict relapses, there’s the possibility (probablility?) that they could die this time. That all the bad things will happen all over again.

When I initially quit taking loperamide, withdrawals were so bad that one night I couldn’t take it anymore and took a few pills just so I could get a few hours of peace and rest. The next day, I attended a meeting and confessed what I’d done — I was EVISCERATED by the group for my relapse. My main mistake was, in explaining what had happened, saying “I know it’s a part of recovery” — to them, this was pure blasphemy, so I was told, in no uncertain terms, that was unacceptable.

Yet, I was not wrong. Relapse is an expected part of recovery. It doesn’t have to be, but it happens more often than any of us would prefer.


Source: JAMA, 284:1689-1695, 2000

Relapse in addiction recovery is no different than any other disease. (By the way, some people differentiate between a “slip” and a “relapse” but, to me, that’s just a matter of semantics. As I will be discussing it, they are the same thing.) Below is a chart that appeared in the Journal of the American Medical Association (reused by the National Institutes of Health) that compares relapse rates between drug addiction and other chronic illnesses such as Type I Diabetes, Hypertension, and Astham. Those illnesses require lifelong patient compliance, frequently with medication, and the breakdown of patient adherence to a treatment plan often causes a relapse of symptoms and repeated medical intervention.


Those who think Substance Abuse Disorder isn’t a disease need to consider this chart carefully.

Relapse is so terrifying because the consequences of it are so dire. As with any chronic disorder, it can quickly lead to hospitalization or death. The diabetic stops taking insulin, it doesn’t take long before glucose builds up and bad things happen. Untreated high blood pressure can lead to strokes and long-term irreversible damage. Untreated asthma can lead to hypoxia and death in minutes. Nobody wants this — but it can and does happen.

The important thing to remember is that relapse doesn’t have to be the end. It is a call to action. Renewed intervention in the disease process can lead to continued recovery with swift and decisive action.

But never give up. Never give up on the family member or friend who slips. And never give up on yourself. Recovery is an ongoing war; the loss of one battle doesn’t need to signal the end.




About madmargaret

Nursing student, Mac nerd, medical 'genius', recovering addict, singer, ex-actor, and all-around swell egg. Really!
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