Substance use is a chronic relapsing condition. This statement is not unusual in the field of substance misuse. Professionals and service users use it. What does this statement mean? It suggests, or is perceived that the substance user, in some way shape and form, has little if any ability to control his or her actions with regard to consuming their substances of choice.
It seems questionable, especially if an individual abstains from using for a period of time and then makes a choice to return to it. We hear the usual justifications. “I could not manage my feelings’, “I self medicate”, “I don’t know how I ended up here”…. The list goes on. As a professional we rarely hear the service user say “I missed it”, “I was simply waiting for the right opportunity” or “I just wanted to return to it”
We have to ask ourselves an honest question. Have we created an environment where a client doesn’t feel comfortable in stating this?
Maybe the terminology of lapse and relapse need to be explored, especially if it is attached to the statement that substance use is a chronic relapsing condition. What if for instance, the service user is activating their freedom of choice, and decides that they want to return to using as they have missed it. It is human nature to return to something that you desire. Maybe, they didn’t actually stop using substances, but put their use on hold or even went through a stage of respite. It is important to remember that if the desire doesn’t go away, it becomes an attractive proposition to return. Desire and enjoyment are unique to the individual, so it is important that the worker does not look at enjoyment from their own perspective.
When someone returns to using, they know what they are doing, and it is a cool calculated plan. If this is the case then we enter in to the territory of a ‘conscious decision making process’. A simpler term for ‘conscious decision making process’ is CHOICE! If we are working with a service user, we could become part of the collusion by saying “I understand, I know you have no control over your actions”. In doing this it may enable the service user, and add to their arsenal of justifications.
It could also be the case for a loved one of a service user. If they also believe the statement they may feel powerless to act. In essence they could feel that they have been held hostage.
Janus is not saying that the work to address a substance using relationship is easy, however ultimately it is all about CHOICE. What do you think?