During my first two and a half decades working in addiction treatment, I was surrounded by the term mental relapse.
Let’s talk about that term.
What is mental relapse? How is it defined?
For starters, mental relapse frames relapse as a process, not an event. It’s the process that begins before using resumes.
To be clear, mental relapse occurs while someone is managing their recovery. It’s not the set of events or processes that occur during periods of abstinence within the active phase of addiction illness.
Mental relapse can be described as a pattern consisting of two things: a relatively long, slow
- degradation of recovery, and
- return of symptoms.
Degradation of recovery refers to a diminishment of wellbeing indicators and self-care–related activities. Return of symptoms refers to an increase in problem indicators—the gradual return of active illness.
Does mental relapse always end in using?
The process of mental relapse might end in using, or it might not.
In that way, mental relapse differentiates a return to using from the return of other aspects of the illness that re-emerge before using occurs.
The signals of the mental relapse process tend to be common across people, while the patterns also tend to be specific to each stage in the process.
By learning the signs and routinely self-inventorying against them, patients can gradually clarify their individual relapse signature. That awareness can be strengthened further by incorporating personal identifiers drawn from feedback from peers and addiction counselors on the treatment team.
Learning to refine this list over time—and doing a daily self-check against a personalized version of it—is empowering.
Ultimately, the ongoing clarification of personal identifiers and daily inventorying of them supports self-efficacy.
How so?
Over time, the personal signs of mental relapse can come to be experienced as ego-alien and ego-dystonic. When that happens, and the process begins to emerge, the patient can name their mental relapse in group and “tell on the disease.” Doing so greatly reduces its power.
In recent years, well-meaning advocates and critics alike have argued that recovery has a single objective identifier: abstinence. And that relapse has a single objective identifier: return to use. Both of these perspectives flatten the recovery lifestyle out of its meaning and reduce relapse to a using event devoid of antecedents. In that worldview, mental relapse disappears—the idea, the language, and the utility.
For decades, there were several common ways these ideas and practices were used.
One was the positive reinforcement of detecting any signs of mental relapse, even before the broader process seemed to have fully awakened. This could take on a fun, almost gamified quality—comparing one’s own awareness to that of counselors and peers.
Another was the enjoyment, relief, and even humor involved in diverting off the mental relapse process, and back into a fuller recovery dynamic, by telling on it. This often enriches the content of therapy and benefits other group members as well.
A third use encoded recovery principles through a repeated script, role play, or similar enactment, such as:
Counselor: “Are you in mental relapse?”
Patient: “No, I’m not.”
Which gradually transforms into:
Counselor: “Are you in mental relapse?”
Patient: “Let me go ask my peers. I’ll be back.”
Patients were often coached to ask one or two peers they felt closest to—and one or two who disliked them the most. The range of material gathered through that exercise is pure power.
As one of my clinical supervisors once told me, “If they take away our terms, they also take away our ability to think about what those terms mean.”
I personally can’t remember the last time I saw a CE training offered on this topic or term.
Our field is losing the concept of mental relapse.
Suggested Reading
Stigma, Humanizing Terms, and Taking On Hostility: A Little More
The Concepts of Psychological Dependence and Physiological Dependence Are Being Lost
Recovery Review 