I was listening to a skilled practitioner of cognitive-behavioral therapy muse about the phenomenon of relapse. Her take: It’s usually a matter of people of people falling away from the practices that enabled them to achieve stable recovery in the first place. Forgetting what they learned about stress reduction or time management or conflict resolution. Letting anger or anxiety escalate beyond healthy norms. When they finally return to treatment after a painful relapse, it isn’t difficult to trace the fall back to its roots, months before, when they stopped ‘working’ at recovery.

The pattern is common: other concerns, responsibilities take precedence. Recovery slips to the rear. It isn’t long before something happens to trigger the emergence of a desire to drink or use. Once you give in, events seem to take on a life of their own.

After examination, client and counselor usually conclude that although CBT can be helpful, you must put it into practice. Just having the knowledge isn’t enough.

This sounds like what AA or NA members hear from sponsors and peers. The 12 Steps benefit only those who make active use of them. Otherwise they’re just words in a book.

And how is this different from the challenges faced by a diabetic or heart patient? If you don’t practice your daily regimen, the odds of relapse increase exponentially.

Look at the cost of noncompliance with medication. Nobody expects insulin to work unless you take it. Why do we expect more from a program of life change that is infinitely more far-reaching?

There are those whose desire to drink or use seems to have spontaneously disappeared– Bill W. is one– but that’s the exception. Most people in stable recovery got there the hard way, through major alterations in the way they live. Whether that was through therapy or religion or 12 Step practice isn’t relevant. The point is, it took time, and commitment, and persistence, and probably faith.

It’s fine if someone wants to credit others, or a Higher Power, for their success. But those in the helping professions should remember that our job is mostly to listen and offer advice. It’s our clients who have to do the really hard bits. ¬†One day at a time.