This series of blog posts first appeared a few years ago on a now defunct blog called ‘Care Training’. It was inspired by the training maxim of ‘making the unconscious conscious’. It is intended to take what really ought to be the most basic principles of health and social care and put them down on paper. The series isn’t only an exercise in stating the obvious though whatever the title might suggest. It’s actually intended as a philosophical foundation manual for workers and informal carers to help them get their care ‘on track’ and then to keep it that way.

A good friend of mine began attending a well known self-help group for problem drinking a few years ago. I’m happy to say that he didn’t attend for very long, partly because he found himself far from convinced about the group’s ‘message’.

He’d been having a difficult time at work and briefly retreated into alcohol as a way of coping. It wasn’t the best tactic he could have chosen by any means and it did start to cause more problems than it solved. It was a response to stress and like many such coping strategies it made him feel better in the short term but only served to exacerbate his troubles in the long term. But it was still a coping mechanism, however self-defeating it may have been over time.

The self-help group he attended took a very simplistic, almost religiose stance. All alcohol was bad, or so they told him and even a single drink would automatically put him right back to square one. They wanted him to believe that he had a permanent, unresolvable problem that could be managed with total abstinence but never ‘cured’.

According to my friend, we’ll call him Tom, the other members of the group accepted this idea uncritically. Presumably that was because those who didn’t accept it left the organisation, as did Tom after a few months. But he did stay around long enough to notice something very interesting.

As the pressures at work lessened he found himself able to drink in moderation once again. He reverted back to previous levels of alcohol use – social and quite infrequent. He stopped getting drunk and found himself quite able to ‘take it or leave it’ as the occasion required. However the other members of the group, those who believed the ‘one drink and you’re back where you began’ mantra didn’t seem able to do that.

During Tom’s time in the group he witnessed a small number of others ‘fall off the wagon’. They too had intended to have only a couple of drinks but they seemingly were unable to do so.

Tom realised that their belief prevented them from controlling their alcohol use. They thought that they must keep drinking after their first little tipple and so didn’t attempt to do otherwise. They defined a single drink as impossible to achieve and nobody tries very hard to do what they think is impossible.

It was a self-fulfilling prophecy

Had those people been able to acknowledge the possibility of ‘lapse’, a single event, they might have stopped at a single drink but since they believed only in relapse or abstinence they couldn’t.

So it’s important that those of us who work in mental health and/or addiction services understand that success in any endeavour (not just in overcoming substance related problems) depends upon both achievements and lapses into previous ways of coping. The lapses are a vital part of the process because, as we saw in a previous entry, it’s how we learn. It is neither necessary nor desirable to convince people that they’ve failed when all they’ve really done is stumble a little along their path to success.

Lapse is different from relapse