The Bounce Back: Focusing More on Recovery, Not Relapse
Each person with a substance use disorder has a different road to recovery.
In substance abuse treatment, therapists and clients should not be disheartened by "relapse" or recurrence, which can happen in recovery.
Therapists should be flexible with clients who experience a recurrence rather than immediately referring them to a higher level of care.
Solutions for those who experience recurrence may include partnering with a recovery coach or gradually building up to larger sobriety goals.
Addiction treatment has kept up with the progressive nature of the times; however, changing perspectives from the original abstinence-only approach has been a slower development. Many people still consider addiction an “all-or-nothing” concept, and to an extent, it always will be. Others have acknowledged the need to personalize treatment on a case-by-case basis. What I’ve come to learn and appreciate through my own experiences working with people with substance use disorders (SUDs) is that the condition is not as black-and-white as it’s often portrayed. What’s most important in my therapy with clients is their ability to “bounce back” after a lapse. I’d like to further my point by explaining the recovery processes of three of my clients. To protect their identities, I will refer to them as “Briana,” “Edie,” and “Roberto.”
The Young Person Concerned About Missing Out
Briana is in her twenties. She presented to treatment for polysubstance use. During her first month in treatment, she experienced a recurrence (more commonly known as a “relapse”) that lasted a few weeks. She reported it began after drinking with her friends to celebrate an event. This became a trigger for Briana, who often said, “I’m only in my twenties! Not drinking at this age is impossible.” With Briana’s concerns in mind, I worked with her on gradually cutting down on her substance use. She continued drinking on occasion but ceased use of all other substances. She has come to realize – somewhat independently – that “drinking isn’t all it’s cracked up to be” and is now sober from all substances, including alcohol. She’s been spending more time with family and friends who match her sober lifestyle and mentality, focusing on her educational endeavors, and relearning and reengaging in some of her old hobbies and interests. The Client Balancing Work, Life, and Recovery
Edie is in her mid-thirties. She presented to treatment for severe alcohol use disorder. Per her level of care, she was expected to begin intensive outpatient (IOP) treatment. However, after one week of engaging in treatment, she returned to work. She realized that juggling both responsibilities became overwhelming and too much to handle without a drink. I continued to work with Edie after a recurrence that lasted a few weeks. We increased her individual therapy appointments, and she agreed to attend one outpatient group therapy session per week instead of continuing in IOP. Edie had a few recurrences after this transition, but she was able to “bounce back” quicker every time. Her treatment plan was individualized to her specific needs, allowing her to address her other life goals, including advancing her career and building healthier habits. Once she felt she had control of managing both areas of concern simultaneously, Edie trusted her ability to maintain her sobriety. She is now several months sober, working towards a job promotion, and is volunteering to help others reach their sobriety goals as well, which she reports has been giving her great pleasure. The Client Who Lacks Connections in Sobriety
Roberto is in his mid-forties. He maintained sobriety throughout multiple levels of treatment, but once he reached the outpatient level of care, he struggled without the consistent structure of daily groups. Roberto began attending individual therapy and couples counseling sessions with his spouse weekly but preferred a program based on “moderation.” Roberto had multiple recurrences, which were less severe at first but became more frequent. Roberto didn’t feel connected to peer-based support groups and often felt as if he was “doing it on his own.” The key to Roberto’s success was working with a recovery coach. Roberto needed to witness recovery for himself through someone else's eyes who also experienced it. He expressed he never knew anyone in sobriety before working with his recovery coach. It was this connection that helped him stay on track. A metanalysis from the Journal of Substance Abuse Treatment points to the effectiveness of peer-delivered recovery support in reducing recurrence rates. A 2018 World Psychiatry study similarly discovered that peer mentors were valuable in encouraging clients to feel empowered, capable, and engaged. Roberto learned to reach out to his recovery coach when times became tough, and he felt triggered to use substances. He began addressing other behaviors with his coach, such as lying to others and is now living an honest life in recovery. He now views himself as a “better husband, father, and worker.” The Bottom Line: Flexibility in Treatment Is Key
Each of these individuals came from a different demographic background. Still, if their therapists had been working from an outdated, “one size fits all” framework, they would have been subject to the same fate. They would have to return to a higher level of care after their first recurrence, leaving them with the feeling that their therapists gave up on them after their first mistake. Imagine each time we made a mistake and the people we believed were supportive gave up on us and made us feel like failures. What would motivate us to get back on the horse and “bounce back?" Finding supportive, creative solutions with my clients throughout their ups and downs kept them engaged in treatment and helped them learn the benefit of living a sober lifestyle independently. By meeting clients where they are, counselors and therapists can motivate individuals to remain in treatment and achieve the successful lives in recovery that they aspire to have.