Recovery Month Observance Begs the Question: Lapse or Relapse?

September 24, 2018

We don’t want the month of September to pass without writing about the subject of Recovery. September is National Recovery Month – held each year to increase awareness and celebrate successes of those in recovery. At Elk River Treatment Program, we don’t encounter many 12 to 18 year olds with true substance use disorders. Not all of our clients enter treatment with substance abuse issues. Of those that do, our Treatment Team most often views their substance use as a symptom of an underlying issue masquerading as a substance abuse disorder. 

Because our program spreads across 120 acres in rural North Alabama without access to distractions commonly used by children to avoid painful feelings, (cell phones, social media, etc.), it doesn’t take very many therapy sessions for them to unearth the root of self-sabotaging behaviors that have put their young lives at risk. Teenagers are very skillful (aka manipulative) at creating distractions whether using legal or illegal substances, making poor peer choices, over- or under-eating, self-harm, out-of-control anger or running away. It takes time and practice for teens to recognize the connection of maladaptive behaviors to feelings/beliefs - to core issues that drive inappropriate responses. For example, after cognitive behavior therapy sessions, Mary begins to realize that her inappropriate sexual behavior is a response to her feelings of inadequacy and lack of self-worth, that is directly related to her father's early abandonment. 

It is a common and unfortunate occurrence for insurance companies to view improvement in behavior as a trigger to remove the recovering client from a nurturing 24/7 care setting into a less restricted environment – usually home with outpatient counseling. (Let's address that in a blog for another day). The more fortunate that are able to remain in residential treatment have the opportunity to practice their new coping skills before returning home. 

Regardless of the time spent in a residential therapeutic setting, returning home can be a challenge with pitfalls that could lead to a lapse of “stinking thinking” or a full relapse into old maladaptive behaviors. Often teens face some of the same triggers that put them on the path to Elk River: Parents that fail to understand core issues and how they lead to negative feelings and beliefs that, if not halted, lead to inappropriate responses. The resulting behaviors as a result of poor peer choices often lands teenagers into residential intervention, and the return home can be isolating and lonely as they search for more positive peer connections. Even the constant electronic stimuli that adults have become accustomed to can be overwhelming to a child that has been in an electronic-free environment and feel that they have been heard for the first time in their life. 

While their child is at Elk River, parents are strongly encouraged to engaged in therapy. They also receive weekly phone sessions from their child’s primary therapist at Elk River and attend monthly on-campus training by Elk River’s clinical team. Among the training is how to respond rather than react to their child’s slips or lapses into old behaviors. But what is the difference in a lapse and a relapse.

Lapse or Relapse?

Generally, a lapse represents a temporary slip or return to a previous behavior that one is trying to control or quit. “We encourage parents to set clear boundaries well in advance of their child’s return home and remove the pressure of coming up with logical consequences on the spot. But don’t be shocked if your child slips into old behaviors from time to time,” ERTP’s Clinical Director Penny Baker said. “Parents should view a lapse as a mistake or a response to external triggers that can be identified and addressed. If a child views a lapse as a personal failure, it could lead to a full blown relapse”, she said.

Relapse represents a full-blown return to a pattern of behavior that one has been trying to moderate or quit. “We coach parents on re-framing their perception of relapse and refrain from overreacting. A single lapse is an opportunity to learn,” Ms. Baker said. Most adults can relate to falling off the wagon when on a diet. Knowing that getting right back on track is the most effective way to achieve your goals. Teach your child that learning and self-awareness is much more effective for long-term success than avoidance and power struggles with parents. Proper communication with each other is vital to long-term success.

Signs of Lapse or Relapse:

  • Return of Denial. Your child is unable to recognize and/or communicate to others what he or she is thinking or feeling. 
  • Avoidance and Defensiveness. Your child doesn't want to think about anything that will cause painful feelings to come back, so avoids anything or anybody that will force an honest look at themselves. He or she becomes defensive when asked directly about well-being.
  • Crisis Building. Your child begins denying his or her feelings, begins isolating and neglecting recovery. Works to solve problems unassisted, but encounters new problems along the way.
  • Immobilization. Freezes. Cannot initiate action. Life begins to take control of the child rather than the child controlling his or her life.
  • Confusion and Overreaction. Can't think clearly, upset with self and everyone around; irritable, overreacts to small things.
  • Depression. Depression evidenced by everyone in contact with the child. Begins to self-medicate. Talks of suicide or self-harm.
  • Behavioral Loss of Control. Unable to control or regulate behavior. Denies being out of control, chaotic problems are created in all areas of life.
  • Recognition of Loss Control. Suddenly he or she realizes the severity of the problems and how unmanageable life has become. They have little power and control to solve the problems. Awareness is extremely painful and frightening. Isolation has made it seem that there is no one to turn to for help.
  • Option Reduction. Your child feels extreme pain and unable to manage life. No longer believes anyone or anything can help.
  • Relapse Episode. Returns to old behaviors/coping skills. Consumed with shame and guilt of failing. Eventually all control is gone and serious bio-psycho-social problems return and continue to progress.

At this point, we recommend inpatient or residential intervention to half the progression and protect the child from intended or unintended self-harm. If for any reason you believe your child is capable of self-harm, call 911 or seek immediate attention at the nearest Emergency Department.