Lapses, Relapses, and Recovery
“I did it again. I told myself I wouldn’t. It was supposed to be a new beginning today. It is 5pm, I wasn’t able to follow my meal plan fully, and now I binged and purged.” Does this sound familiar? If you are working toward recovery from an eating disorder, this may be familiar. Or maybe the behavior you engage in looks different - such as over exercising, only eating organic foods, not hydrating your body, or engaging in substance use.
Whatever the behavior of choice is, there is a common theme….eating disorder and substance use recovery is difficult. It is not a linear process. The journey is filled with ups and downs, twists and turns. Throughout the process, it is important to stay focused on the goal…recovery.
What are the Differences Between a Lapse and a Relapse?
Let’s say you are walking on the sidewalk and you trip, you fall, but you get right back up, brush yourself off, and continue walking. That is similar to a lapse. According to the American Heritage Dictionary (2000), a lapse is “to fall from a previous level or standard” or “to slip”. A relapse on the other hand is to “return to a former state” or “recur”. If we take the example of walking down the sidewalk, a relapse would look more like tripping, falling, and staying there for a while. You don’t get back up and start again but rather return to a former way of living. It is important to know that whether you are in a lapse or a relapse, recovery from an eating disorder or substance use is possible! You can choose to get back up and invest in your recovery.
What To Do if You Are in a Relapse?
Be honest with yourself.
It is crucial to acknowledge that you are struggling and that you need help. In order to get back up, honesty is the first step.
Have accountability.
Who are the people in your life that you can turn to for help or accountability? This may be a therapist, a sponsor, a dietitian, a pastor, a family member or friend. Recovery does not happen in isolation. Community - people who know your struggle and can hold you accountable in a kind and compassionate way - is necessary.
Take one moment at a time.
Anxiety and overwhelm like to live in the future. All the “what ifs” plague your mind. Or you feel depressed and defeated because you focus on the past and feel hopeless that anything will change. One skill (that requires practice) is to bring your mind into the present moment. A full day at a time may be too much. Just focus on the next five minutes, or the next moment! Bring your awareness into the here and now. One way to do this is to use your five senses to ground yourself. What do you see, what do you hear, smell, taste, and what can you touch? Then describe those things. Begin to ask yourself “what do I need that is healthy and effective, to just get through this moment”. Maybe it is a call to a friend, a meeting, journaling, taking a mindful walk, spending time with pets, doing a puzzle. There are several options. The goal is not to take away the struggle, but rather to help you tolerate the emotion or the urge until it shifts.
Start now.
Make the choice to begin now. You don’t have to wait for someone to tell you, or for you to fall harder. Just stand up, brush off your knees, and begin to walk again. You can do this!
Treat yourself with kindness and respect.
One of the things I hear so often is the shame spiral that gets activated with a lapse or relapse into eating disorder or substance use behaviors. Shame only serves to keep you in isolation or a destructive mental, emotional, and even behavioral space. What would you say to someone else if they had a lapse or relapse? Would you speak to them the way you internally speak to yourself? Most often, the answer is no. Rather than self condemnation and shame, see if you can begin to offer kindness and respect to yourself. For some, the word compassion may be a stretch, or feel impossible. But, most of the time, people treat complete strangers with kindness and respect. If you can do that for a stranger (you don’t even know or even necessarily like the person), hopefully you can begin to provide that to yourself as well.
What is Relapse Prevention?
When in eating disorder or substance use recovery, it is important to develop, in advance, a relapse prevention plan. This is something that you begin to implement far before you have a lapse or relapse. It is also something that in the event you do have a lapse or relapse, it will give you specific ways in which to get back on track.
Here are some things to include in a relapse prevention plan.
Warning Signs of a Relapse - What are your personal warning signs? One way of doing this is through utilizing the image of a green light, yellow light, and red light. Identify the physical, emotional, relational, mental, behavioral and spiritual warning signals.
Green is when you are solid in your recovery, yellow is a warning that things are on shaky ground and a slip is on the horizon, and red is when a lapse or relapse is most likely going to happen at any moment.
A Team of People - Including an emergency contact list. List your therapist, sponsor, dietitian, psychiatrist, health professionals, and any other people who are supportive and part of your recovery process. Also include crisis numbers and hotlines that are available 24/7. Have it readily available and in a place that is easily accessible for times when you need it. You can create a note in your phone as well as have it hanging somewhere visible as a reminder.
Identified Triggers - With your therapist, identify the people, places, things, events, music, smells, and activities that trigger your urges to use unhealthy behaviors. Try to notice them without judgment. These are important for you to be aware of so that you can work to mitigate triggers if you can, or prepare in advance if there will be a known trigger that you will encounter. When you have awareness and can prepare in advance, it empowers you to make wise choices.
Apparently Irrelevant Decisions - These are decisions that are made that seem ok, seem harmless, but in actuality set you up for a potential lapse/relapse. If you are sober, this may be you attend an event where alcohol will be served and easily accessible. In recovery from an eating disorder, this may be going to a store that used to be where you regularly binged and purged. These are decisions that to the outside eye, who doesn’t know your history or struggle seem like a harmless decision, but for you they are filled with high risk. Make a list of what these apparently irrelevant decisions are for you and work to reduce your risk of slipping into old behaviors.
Structure and a Schedule - Having a structure and schedule for your days enhances recovery. Set yourself up with a plan that includes daily responsibilities, nutrition/meal times, joyful movement if approved by your medical/dietary team, rest, recovery oriented activities, and other things that you desire to include that you know are beneficial to you. You can put your schedule on your phone, on paper, or in a planner. Work to stay consistent with your schedule, while also knowing that some things may need to shift or change and that is ok! It does not have to be perfect.
Effective Coping Strategies - What are the coping skills that work for you? Not all coping skills work for every occasion. Having a toolbox of effective coping strategies that you can pull from is important. Try to make a list of 3-5 skills for each trigger, emotion and urge. Be specific about what coping strategies you can implement during these times. If you find one isn’t helpful, then try another! We know that urges do eventually pass! Even though the urge may be strong, you do not have to act on the urge. The urge is just an urge! It does not require the action to be completed. Work to use your coping skills -the more you use them, the stronger they become.
Recovery from an eating disorder and/or substance use is both a difficult and rewarding process. It is a road filled with twists and turns for many. Yet, don’t lose hope!
