Rethink Relapse

drugdealsBy this stage of my career (meaning I’m old), I thought I had encountered most of the attitudinal terminology debates in the addiction and mental health fields.


By: David Mee-Lee, M.D. | 5221 Sigstrom Drive | Carson City | NV | 89706


In fact, if you are a longtime reader of Tips and Topics, you know that I have addressed often


the attitudes behind certain words we use: “manipulative” and “compliance” versus “adherence”, “attention-seeking”, “borderline” etc.


When reading a 2012 interview of William R. Miller (Motivational Interviewing) by another giant in the addiction field


William L. White (Recovery in addiction and recovery-oriented systems of care), I was surprised I had not considered the issues behind our common use of “relapse” in addiction treatment.


TIP 1


Notice your attitude and actions when you talk about “relapse”, especially when your client has just “relapsed.”


Listen to what Bill Miller says: “Well, it’s a term borrowed from medicine, but in our field, it takes on very pejorative, shaming overtones. When you’ve “relapsed,” it’s pretty clear you’ve done something bad and it’s your own fault.”


You might say: “No” I don’t shame anyone for relapsing – it’s all part of the disease of addiction.


Maybe you don’t treat clients as if they’ve done something bad and blame them for a flare up of their illness, but lots of your colleagues still do.


Otherwise, how come most programs still have policies like this: If a client shows up to an outpatient group with alcohol on their breath because they drank a few beers,


or they shot up some heroin, or smoked some crack, what happens? Staff checks to make sure the client is not immediately unsafe.


But then what? They are told to go away and come back later when they are sober.


Depressed Clients


Imagine doing that to a person suffering from Major Depression. They have a flare up of suicidal ideation, but are not so suicidal as to need hospitalization.


Would you tell them to go away and come back later when they are not suicidal?

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