Stigma, humanizing terms, and taking on hostility: A little more

February 7, 2021
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Earlier today Jason Schwartz posted on the notion that the word “relapse” is stigmatizing, that the preferred term is “recurrence of use”, and the lack of empirical evidence addressing this topic.

I will add a little more.

“Relapse” is currently my preferred term rather than “recurrence of use”. Why?

In clinical work focused on relapse prevention, the term “relapse” means “return to symptoms”. The basic idea is that one monitors symptoms, and redirects accordingly. This basic approach is used for many primary health and mental health problems.

In the case of relapse prevention therapy (RPT) for moderate to severe substance use disorders, one mobilizes to identify symptoms and redirect prior to use as well as after.

Similarly, in the Transtheoretical model of change, also known as “Stages of Change” (SOC), the stage called “relapse” signifies a return to symptoms and does not only mean “return to use”.

At a professional conference some years ago I presented a break out session on relapse prevention. The conference materials included the phrase “recurrence of use” describing the session.

I started the session by mentioning the new thinking about some of the possible problems associated with the word “relapse” and the push to replace that word with the phrase “return to use”.

Next, I explained the reasons for my reluctance to make that change, at that time. I emphasized that:

  • We need to not lose certain important ideas found in Relapse Prevention Therapy, regardless of words.
  • As we train new clinicians we should retain a focus on the early phase of return to symptoms, identifying symptoms, and redirecting both before and after use resumes.

There are at least two major and separate approaches to Relapse Prevention Therapy that use the word “relapse” as a technical term. These approaches have differing theories, glossaries, and methods.

The model by Gorski is one of the two models. Gorski’s RPT is derived from aggregating real clinical experiences. The model by Marlatt is the other major model. Marlatt’s RPT is derived from aggregating results of research and is rooted in Cognitive-Behavioral Therapy.

For me, both of those schools of RPT, when combined with the Transtheoretical model of change, equal the necessary and sufficient clinical consensus on the usefulness and appropriateness of the word “relapse” over merely saying “recurrence of use”.

I look forward to research studies examining the impacts of these differing words and terms. Hopefully underlying attitudes will be examined as well, so we can better identify everything that is important for us to change, and to retain.

I’ll mention that this area of inquiry reminds me of the work I read in the 1980’s and 1990’s by John Caplehorn examining impacts of clinician and clinic attitude during methadone maintenance in Australia.

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