Relapse Prevention, Recovery Management, Recovery Transcendence

7272382 - beautiful sunsetI have tremendous respect for the work Dr. Alan Marlatt, Dr. Dennis Daley, Terrence Gorski, and others have done pioneering the field of relapse prevention (RP), but I have always been troubled by the relapse language and making RP a focal point in addiction treatment. My concern is threefold. First, the lapse/relapse language is drawn from moral rather than medical discourse and drips with centuries of stigma and contempt that have long been heaped on people experiencing alcohol and other drug-related problems (see earlier blog). Second, characterizing all AOD problems and related disorders as “chronically relapsing” misrepresents the natural course of such problems (grossly underestimating recovery stability and durability) in a way that increases personal, therapeutic, and cultural pessimism regarding the potential resolution of such conditions (see earlier blog). Third, and the focus of the present essay, the RP lens risks inadvertently casting personal and professional attention on deficits and vulnerabilities rather than assets and casting one’s vision backward (to the potential for resurging pathology) rather than forward (toward a flourishing and meaningful recovery). The image is one of running from something (the beast/dragon images often come to mind) rather than being positively drawn toward something of great value of one’s own choosing.

A lens of recovery management (or recovery enhancement) (RM) has advantages not achieved by the RP framework. The RM shift might be cast as “recovering from” to “recovering to,” with the potential for a process of discovery that transcends the recovery experience—a journey traversing from, to, and beyond. The prepositions here are important. We should build on what has been learned within relapse prevention research and practice while focusing on what makes us come alive rather than on what we most fear. At its most practical level, RP and RM are distinguished by a focus on what is not wanted versus what is desired, e.g., debt counseling versus wealth management, disease management (symptom suppression) versus recovery management (facilitation of healing and wholeness), marriage counseling versus marriage enrichment, a focus on correcting defects of character versus expanding character assets, interests, and social contributions. RP might be thought of as “vulnerability (demon) management”; RM might be thought of as “potential management” (e.g., the cultivation and management of a pleasurable, engaged, meaningful, and contributing life).

The RP to RM shift suggested here is part of a larger transition from pathology and treatment paradigms to a recovery paradigm within the AOD policy and service arenas. I am not suggesting that the nuts and bolts of RP be cast aside, only that it be renamed, reframed, and balanced with an emphasis on building personal, family, and community recovery capital. If recovery is more than the removal of alcohol and other drugs from an otherwise unchanged life, then the focus of recovery support interventions should shift from a strict RP focus (a process of problem subtraction) to an RM focus on achieving global health (a process of addition) and increasing one’s potential for a both personal fulfillment and social contribution (a process of multiplication). There is a difference between the prevention of illness and the promotion, achievement, and transcendence of wellness. The field of primary medicine required centuries to discover this simple maxim, and it is still struggling to grasp its full clinical and social implications. Hopefully, the same will not be true for the alcohol and other drug problems arena.

Of Related Interest and Highly Recommended: Krentzman, A. R. (2013). Review of the application of positive psychology to substance use, addiction, and recovery research. Psychology of Addictive Behaviors, 27(1), 151-65.