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Back to basics to prevent relapse

November 21, 2013
by Heidi Voet Smith, MA, LPC
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Heidi Voet Smith, MA, LPC

Jessica has been given every opportunity to get sober. Her parents got her help as soon as they realized she had a problem. She has visited numerous detox centers, the best treatment centers in the country, and highly respected sober living programs, she has participated in monitoring efforts, her family has worked with interventionists and case managers, they’ve tried tough love, they’ve supported her, they’ve not supported her … and Jessica continues to relapse.

Dawn has used up all her resources—she’s been to every treatment center for the indigent in her surrounding area at least twice, she has spent time at numerous homeless shelter rehab programs, she’s been on methadone and Suboxone, she’s been in and out of the local Alcoholics Anonymous (AA) group for years, and her state funding has run out so she can’t get any more treatment … and Dawn continues to relapse.

Everyone seems to have a theory as to why individuals such as Jessica and Dawn continue on a cycle of chronic relapse. Some of these theories are more popular than others, while some come and go depending on the decade. Here are some examples.

Theory #1: Relapse happens because that is how individuals are conditioned. With repeated aversion therapy, drugs and alcohol will lose their appeal.

Theory #2: Relapse happens because of failure to cope with a triggering situation, and can be prevented by intervening at different points in the chain of behaviors.

Theory #3: Relapse happens because an individual is self-medicating a mental illness. Chemical dependency is a secondary symptom that will disappear when the underlying mental illness is adequately treated.

Theory #4: Relapse happens because an individual doesn’t have enough self-will, good habits and moderation. These things can be learned.

Theory #5: Relapse happens because an individual is still ambivalent and is not ready to take action to change. A professional can help an individual move through the stages of change with good technique.

Theory #6: Relapse happens when an individual has unresolved issues with trauma. When these issues are resolved, the individual finally will get well.

Theory #7: Relapse happens because of uncontrollable cravings. With the right medications, cravings will go away. Clients may need maintenance drugs for the rest of their life.

Theory #8: Relapse happens because an individual failed to avoid old people, places and things.

Theory #9: Relapse happens because individuals don’t know how valuable they are and don’t believe in themselves or love themselves (this is a favorite theory of mothers throughout the years). With enough affirmative self-talk and new beliefs, they will break the cycle of chronic relapse.

Most treatment professionals would agree that they align themselves with a few of these theories and that the core issues vary with each individual. So, with all of these amazing theories and techniques in our toolkit, why does it seem that relapse still occurs at such epidemic rates?


Spiritual void

Let’s look back at some theories of chronic relapse that I did not already cover, coming from the 1930s during the genesis of AA. William D. Silkworth, MD, was director of Charles B. Towns Hospital for Drug and Alcohol Addictions in New York City, then one of the most well-known hospitals in the country for treating addiction. Silkworth, the first physician to endorse the program of AA, believed that relapse happens because an individual has insane thinking regarding alcohol even when sober and feels emotionally and spiritually uncomfortable without the ease and comfort of alcohol. The only way to stop the cycle of relapse, then, is to have psychic change through a spiritual experience.

Carl Jung, the founder of analytical psychology, also developed a theory on relapse into addiction. Jung’s theory on relapse, which was also discussed in the Big Book of AA, was that relapse happens because of a void for God. Spirituality is the only way to combat alcoholism, Jung believed, and a “vital spiritual experience” is absolutely necessary for a chronic relapser to get and stay sober.

Jung in the Big Book described a spiritual experience as “a huge emotional displacement and rearrangement. Ideas, emotions and attitudes which were once the guiding forces of the lives of these men are suddenly cast to one side, and a completely new set of conceptions and motives begin to dominate them.”

Silkworth and Jung both admitted that despite years of effort, they remained inadequate when treating this certain type of hopeless alcoholic, and that creating a powerful spiritual realignment was far beyond the human power they possessed. They both were very clear that a spiritual experience is necessary to end the cycle of chronic relapse. In addition, they both endorsed the 12 Steps as the best way to induce or create a spiritual experience, which is exactly what the Steps were designed to do.

Research supports Silkworth and Jung’s theory that a spiritual experience is necessary for lasting sobriety. A 2011 study published in the Journal of Studies on Alcohol and Drugs found that changes in spirituality at six months could predict better drinking outcomes at nine months.1

Another 2011 study assessed 1,726 alcohol-dependent individuals at treatment intake and at 3, 6, 9, 12 and 15 months regarding their 12-Step meeting attendance, their spiritual practices and their success in staying sober. The assessments found that 12-Step attendance was clearly associated with an increase in spiritual practices, especially for those who engaged in few spiritual practices before joining the study. In this study, results showed that AA was consistently linked with better sobriety outcomes, which researchers found was partly due to the increase in spirituality.2




I am reminded of how far we have to go as a treatment filed when it comes to recovering from addiction. What's most frustrating is that so many 12 Steppers (I'm 12 years in AA) are unwilling to evolve. What that means to me is that we cannot see beyond the way WE recovered to see that it's only ONE PATHWAY to recovery and THE ONE. I agree that FOR ME spirituality was important but that may not be true for the next guy and to have the gall to tell them that they cannot recover because they don't get it is not only ignorant but unethical.

I want to take issue with the inappropriate remarks made by aaiou1 in the 11-22-13 comments section, regarding Heidi Voet Smith’s article “Back to Basics to prevent Relapse”. Smith is simply suggesting that 12-step treatment programs are most effective when adhering to fundamental 12-step philosophy especially emphasizing spirituality. She goes on to site references in the Big Book in support of this point of view. She never suggested that a 12-step approach was the “only ONE PATHWAY to recovery”, she never advised counselors to have the “ignorant and unethical gall” to tell anyone that they “can’t recover because they don’t get it”.
Submitted by Andrew D. Bennett, CADC II.

Heidi, " self-help is not treatment."!! You are the one in charge; where is your informed consent supporting the patients right to choose? When patients walk in your facility , I bet there's only 12 and 12 posters and 12 step meetings, right or wrong? Do you know there were 26 states where the Supreme Court's ruled you cannot mandate attendance at a rehabs nightly AA meeting if a LAY (nonreligious) alternative is not available? (It means the courts saw AA was "religious enough" to violate the Constitution) I hope my comments just now stimulate a dialogue between Us, they were not meant to disrespect you just get your attention. I would very much like to be of assistance to you who whose heart is in the right place, please write back, take care ,
Andrew Park LCSW CASAC. DAP.