Leeza

Slip, Lapse, Relapse

Discussion created by Leeza on Oct 21, 2013
Latest reply on Oct 21, 2013 by Giulia

I thought that I would share an article that discusses slip, lapse and relapse.  There seems to be much discussion about this lately out in the blogs.  This article is presented here solely for educational purposes.  I think that even "recovery professionals" do not necessarily agree on the terminology.  In my opinion, the most important thing is to get back to your quit immediately for the longer you wait the harder it will be to get back on course.


Here’s an excerpt from Smoke-Free Smoke Break  (P. Somov & M. Somova, 2011) on slip/lapse/relapse prevention training.  This particular excerpt is tailored to smoking but the idea applies to any drug of choice (and is originally adapted from Recovery Equation, Somov, 2003).

Slip, Lapse, Relapse

The goal of slip, lapse and relapse prevention training is to help you to stay abstinent from smoking, that is, to prevent abstinence loss. In our analysis, there is substantial confusion about what constitutes loss of abstinence. If your dermatologist (skin doctor), without any testing, told you that a dark spot on your forearm was melanoma and turned out to be wrong, you’d fire that doctor.

The recovery industry does this sort of thing every day when it confuses a slip with a lapse and a lapse with a relapse. These three are, of course, not the same. So, once and for all, let’s end this lingering confusion and make sense of abstinence loss with the help of a “banana peel” metaphor that we developed for working with substance users.

Slip and Slip Prevention

Say you are walking down the street and see a banana peel. When you see the banana peel and realize its slippery potential, you might walk around it to avoid a slip. In this see-but-not-slip scenario, you are preventing a slip (slip prevention). If you hadn’t been paying attention, you would have stepped on the banana peel and slipped, that is, lost your balance.

What’s the banana peel in this scenario? The banana peel here is a metaphor for a craving. A craving, as you recall, is when you are living your life in a state of functional balance, and then, bam—you want something really badly, and your mind starts leaning toward something that you want, almost tipping and falling over unless you catch it with craving control.

So, in this case, a smoking-cessation slip is when you have a desire to smoke after you quit. How can you prevent a slip? By staying away from whatever it is that triggers your smoking. For example, if you quit yesterday and have dinner in the smoking section of a restaurant today out of habit, you are dancing on the banana peel of craving. But even though you have not prevented the emergence of the craving, even though your craving mind jeopardizes your recovery balance, it doesn’t mean that it is too late and you will fall. Of course, it’s not too late. You can still prevent a lapse. Read on.

Lapse and Lapse Prevention

Say you are walking down the street without paying attention. So you step on a banana peel and, as a result, slip up; that is, you lose your balance. Reflexively, you flail your hands and gyrate your torso to regain your balance. And voila! You do not fall, despite having slipped. You regain your balance and prevent a fall. In this slip-without-falling scenario, you prevent a lapse (a fall), which constitutes lapse prevention.

Distinguishing between a slip and a lapse makes good sense. An act of slipping does not equal an act of falling; the two are psychologically and behaviorally different events, which is reflected in the actual semantics of the words involved: a “lapse” literally means a fall, a “slip” does not mean a fall and therefore does not equal a lapse.

Let’s pick up the craving scenario that we put on hold a moment ago. You quit yesterday; and today, out of mindless habit—which is natural—you find yourself eating in the smoking section of a restaurant, feeling overwhelmed by a craving. The fact is it’s too late to prevent a slip, that is, to prevent the craving; you are already tap-dancing on a banana peel, compliments of mindlessness. But just because you are losing balance doesn’t mean you have to fall, that is, lapse. No, you can still prevent a lapse. How? With craving control. Kill the craving to regain your balance.

Relapse and Relapse Prevention

Say you are walking down the street without paying attention. You step on the banana peel and slip, that is, lose your balance. You flail your hands and gyrate your torso to no avail. You are not able to regain your balance, so you fall (lapse). As you try to get back on your feet, you might fall again (relapse).

The three reasons you might fall again while trying to get back up are: you got too hurt and it is too painful to get back up; you lose your balance and fall again as you try to get up; and you feel a little shaky and unsteady on your feet, and because you have nothing to lean on or support yourself with, you fall back down again. If, however, you look around and mindfully size up what you need in order to safely get back on your feet, if perhaps you first calm down, rest, and ask for help propping yourself up as you get back on your feet, you just might be able to prevent another fall (relapse), which would constitute relapse prevention.

Let’s get back to our restaurant scenario. You quit yesterday and mindlessly found yourself in the smoking section of your neighborhood restaurant, feeling overwhelmed by a craving to smoke. Is it too late to prevent a slip (a craving)? Yes, you already have a whopper of a craving and can’t rewind back in time to a moment before you chose where to sit. So, slip prevention is out of the question.

What are you trying to do? You are trying to regain your mind’s balance. How? By using craving control. So, here you are: having slipped on the banana peel of craving, you are trying to regain balance with the help of craving control. But, let’s say you can’t. Even though you are doing your best, the craving gets the best of you. So, you bum a cigarette, smoke it, and return to finish your meal. What happened here? You lapsed. First, you slipped, that is, got a craving. Then, you tried to prevent the fall, the lapse, with the help of craving control, and it didn’t work.

So, you lapsed; you had one cigarette. What’s next to prevent a relapse? What would be a relapse in this situation? The relapse here would be to decide that you are done with this smoking-cessation effort, at least done for now, and to buy a pack on the way back home.

Now, just because you have lapsed, or fallen, doesn’t mean you have to stay down. You can still prevent a relapse. How? With the same old craving control and access of support if you need to.

Outcomes