Just passed 100,000 page views on New Year’s Eve, most of them no doubt on the “Why We Don’t Get Better Immediately” page.
I’m not a stats watcher. What’s important to me is that people are getting the information they need. Thanks to those of you out there who are pointing out WWDGBI as a source for people who don’t understand PAWS. If each person who found the article helpful would pass it on to just one or two more people, first thing you know we’d have reached a lot of folks.
Anyway, I hope you survived “Amateur Night,” and I wish you all a safe, healthy, sane and sober 2013. (Well, mostly sane.)
What...Me Sober? 
Hi Heather,
It’s good to hear from you again, and that’s an interesting question. There are several numbers you hear bandies about, and none of them are really accurate. Here’s why.
Relapse is difficult to measure. Obviously (when you think about it), it occurs before we use. If we weren’t already in relapse, we wouldn’t use, would we? So if I don’t use, did I relapse or just come close?
Recovery is about making the physical, social and mental changes that take us away from our old ways of thinking and develop new ways of looking at the world that allow us to live relatively happy, healthy, sober lives. Recovery is a continuum, not an event, and we can move in either direction. It is even possible to stop dead in our tracks and move in neither direction.
Some of us stop using but do nothing to change. We call those folks dry drunks, and as the saying goes, “If you sober up a horse thief, all you get is a grumpy, more efficient horse thief.” If they later use, should we count that as a relapse? After all, they were never really in recovery. It seems to me that for people who started off making progress, relapse occurs when we begin sliding back to our old ways of thinking and behaving. Using simply makes it impossible to ignore any longer.
This brings up the obvious issue of measuring recovery. How do we do that? Recovering people clearly move along the continuum in a positive direction. Their attitudes improve, they exhibit willingness to change, and do so. They seek out positive relationships and nurture them. They become more truthful and compassionate. They recognize that false confidence is a trap, and try to remain realistic about their progress and prospects. They are willing to share what’s happening in their lives and accept feedback. They make an effort to become a part of the outside world, while retaining their connection to the recovering community. And, finally, they help others achieve the same goals.
Conversely, to the extent that they do not make those changes, or move in a negative direction, they are either not in recovery or are in relapse.
The second big issue is counting those who relapse “officially.” How do we do that? We know that a great many people who enter detox facilities do so more than once. But if they don’t return, are they still clean and sober? Did they die? Did they move? Did their insurance run out? Did they get clean after going “cold turkey?”
Many people think that the 12-step programs ought to be able to answer those questions. But how? That word “Anonymous” is a huge barrier. Who keeps the central database? Who takes and validates the surveys? How do we tell one drunk named Bill W. (a co-founder of AA) from another Bill W. who is an addiction educator (me)? The figure we hear bandied about in the rooms is usually in the 10 to 30% range for eventual recovery. Is it accurate? No way to tell.
A study by the National Institutes of Health (available here) was of little concrete help, but did point out other complications of studying these things. How many people went into treatment facilities? How long was the treatment? How many people participated in AA or another self-help group? How many did both? How many used, but participated on a second try? How many of those who participated in groups on the first try relapsed, and how many went to treatment subsequently? You can go on and on with these combinations, and resolve little or nothing. (The follow-ups on this particular study were done by phone. How many of those people simply lied out of embarrassment? Etc. Etc.)
A large chain of treatment centers (Caron.org) estimates relapses at 70 to 90%, but how is that measured, and how many of those people subsequently get sober? Who knows?
My own feeling, simply anecdotal, is that the accurate figure is someplace in Caron’s range of estimate. Addiction is a disease, and one of its symptoms is relapse. We can expect anything that is considered a “symptom” of a disease to occur more often than not, and for the numbers to be significant. It also gibes with my experience working in treatment and detox.
The bottom line: The important issue is not how many make it, but whether we, as individuals, are doing everything we can to insure that we continue to move in the right direction. One of those things is helping others to achieve sobriety. If we are doing our best, then the chain builds itself, one link at a time.
And no one can answer that question but you.
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Hi Bill, I was curious to know… on what % of people relapse? I have tried many times before to become sober and finally found a program that works. I have no intentions of relapsing. Out of curiousity I was wondering what is the average relapse rate?
Thanks
Heather
(Congrats at 100K)
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Amateur Night, indeed. I stay home and off the roads. Well, except for my 7:00 PM meeting :-) Have a great New Year my sober blogging friend.
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