Preventing Relapse: A New Vision

By Paul D. Alleva, MSW

addicted man looking in mirror seeing different image of himself

Drug treatment is often considered ineffective at best. At times, it appears that self-help is almost as effective as treatment and it’s free! A major change has to take place in the drug treatment field especially in relation to relapse prevention in order to better our outcomes.

The focus in treatment centers has been a cognitive understanding of the disease of addiction. Patients learn about the disease but not enough about the recovery process. In the perception of some; treatment centers have become pimps for relapse more interested in another opportunity to bill another inpatient episode than insuring there is enough support upon discharge to maintain sobriety.

For many years in the treatment of addiction, we tried to move away from the moral model and understand that addiction in part was a disease, but we now have moved too far into reliance on medicine pharmaceuticals, and cognitive behavioral therapy as the solution to addiction.

Addiction is much more than a mechanism in the brain that malfunctions or a problem that can be solved by logic and self- education. If all we needed to handle negative behavioral issues was a new logic model, we could give every addict, diabetic and gambler a book on behavioral adjustment and assume the cure. But it doesn’t work that way!

There needs to be a motivation to change behavior and it is irrelevant if the disorder is medical in effect because cure is psychological and without a reason emotionally, spiritually or otherwise to change, behavioral relapse is inevitable. Therefore, motivational therapy and a change in personal identity are crucial for success.


Change in identity is key to relapse prevention. The addict who thinks himself as only an addict is doomed to be an addict. Only a change in identity can secure a positive outcome. Thinking of yourself as a recovered addict is key to the solution. Recovered people do not continue with old sick behaviors. The way people see themselves dictates how they behave.

People need to identify with their health not their sickness. As a treatment provider we hear all too often “well I’m an addict so I was bound to relapse.” Unless an addict makes a commitment to recovery and sees himself as healthy he will relapse because he will not believe true recovery is possible. As Phil Diaz MSW says, “As someone with 42 years clean and sober, I am aware how important it is to view myself as someone for whom alcohol or drug use is no longer an option. In the end, recovery is mostly a decision to change identity from a user to non user, from a sick person to a healthy one. I consider myself a recovered addict and the big book of AA refers to people in the same way.”

Treatment centers need to help clients create healthy successful identities that focus on their strengths and assets rather than their weaknesses and their deficits. Treatment needs to focus on creating new productive lives and less on the addiction and the past. All of us, at some point in our lives need a fresh start.


Two things need to be present to avoid relapse. One is a change in the person’s relationship to his or her drug and a presence of community support that the person can rely on for help when he or she is triggered and the desire to use a drug re-emerges.

The first part of avoiding relapse is to change ones relationship to his or her drug. In clinical terms, this is called reaction formation. Reaction formation is a simple process which usually insures sobriety. It is a process in which the patient makes the object of his affection, in this case his drug of choice into the object of distain. So where alcohol was once a revered friend, in recovery, becomes the enemy.

This simple process establishes an aversion to drug use on a very basic psychological level. It is the process that most successful addicts go through in AA and NA. They become warriors in the fight to heal others from drug addiction rather than contributors to drug use. Twelve step work becomes both a reminder of the new found relationship to drugs and reinforces their decision to view drugs as the enemy they must fight.

A community network must also exist to support sobriety and to avoid relapse. This new work can be self-help programs, the church or synagogue or any group which can help the addict to think through his impulse to use and support the use of new coping skills for releasing stress.

In our treatment center we say that alcohol and drugs are not the problem- they are the solution to the problem. And if we don’t find the problem that is precipitating drug use then it is very hard to stay sober. Alcohol and drugs are very destructive coping mechanisms which must be replaced. Alcohol and drugs have served to numb the pain of living that most addicts live with. Most addicts take drugs and become isolated from others as a solution to their life trauma.

Human connection is the key remedy for the relief of any problem. Human connection removes the isolation and creates new coping tools. AA and NA provide and prescribe human connection which is essential for their success. In the end, treatment centers need to become healing community builders.

In the end, we must return to our roots as healers and redefine helping as a service not solely a business. We must look to supply our patients with all that they need regardless of the possibly that we will not be paid for that service. As Diaz says, “In my 42 years of recovery I have seen treatment change from a spiritual mission to heal to a very lucrative business that in the end must seek to perpetuate itself rather than eradicate the problem. In the end, drug use is a spiritual problem. It exists because of vacuumed meaning in people’s lives which they try to fill with sex, money and drugs when what they really need is love, human connection and a sense of real community.

Paul D. Alleva is the founding owner of Lifescape Solutions and Evolve Mental Health which he opened in December of 2011, based on a new model of healing and psychotherapy called Spiritual Growth Therapy. His newest book Let Your Soul Evolve: Spiritual Growth for the New Millennium 2nd edition describes the model.