You Get to Decide What Happens Next: On Slips, Compassion, and the Language of Recovery

By Layne A. Gritti DO, Adult, Addiction, and Perinatal Psychiatrist

Let’s Start with the Word “Relapse”

Language shapes how we feel about ourselves. In medicine, sometimes we understand this. We don’t say a person with heart disease “failed” when they have another cardiac event, or that someone with diabetes “relapsed” when their blood sugar climbs. We recognize those as expected features of chronic illness, and we respond with clinical attention and care.

Addiction is a chronic illness too. Yet, somewhere along the way, we adopted a stigmatizing, judgment-laden vocabulary for it. Take the word “relapse.” It carries a moral weight not found elsewhere in medicine. It implies backsliding, weakness, failure. Shame is a prevalent feeling found in addiction spaces. Yet, it is altogether unhelpful for recovery. It puts the blame squarely on the person rather than on the nature of the disease. (We treat obesity like this too, but that’s a conversation for a different post.)

In my practice, I instead talk about a return to use, or a slip (a brief return to substance use in the context of recovery). Not because I’m softening reality, but because accuracy and compassion matter. We do not yet know, when someone has a slip, if they will return to regular use. Trying to predict the future takes some of the power away from the patient, casting a return to use as inevitable. So, how we talk about slips and return to use changes what happens next.

Addiction Is a Lifelong Disease. That’s Not Defeat. It’s just Truth.

One of the most important things I remind my patients of is something many of them don’t want to hear: recovery doesn’t have an end date. Addiction is a chronic disease, a type of a brain. There is no point at which you are “cured” and can stop being mindful. Addiction affects the brain in lasting ways, and those changes don’t disappear after months or even years of not using.

I’ve seen patients who went a decade without using a substance and then experienced a return to use. A DECADE. When it happened, the shame was crushing, partly because they had allowed themselves to believe they were past it. That the vigilance could finally stop. So they “failed.” But is it failure, or is it just the nature of the disease?

This isn’t meant to be discouraging. It’s meant to encourage vigilance.

When you understand that addiction is a chronic condition requiring ongoing awareness, not a battle you either win or lose, you stop measuring your worth by your streak. You start measuring it by how you respond when things get hard.

Nobody Wants to Plan for a Slip

I created a document to help my patients plan titled “Slips and Compassion” because I kept running into the same dynamic in my office. I’d ask patients to think about what they would do if they experienced a return to use, and the resistance was almost universal. Nobody wants to imagine the circumstances in which they might use again or that it is even a possibility. I’ll give them the homework to fill out the handout, but it doesn’t get returned.

I get it. When you’re doing well, making a slip plan feels like tempting fate. Like you’re expecting to fail, or giving yourself permission to. But that’s not what it is. A slip plan is a fire extinguisher. You don’t put one in your kitchen because you expect to start a fire. You put it there because if one ever starts, you want to be ready. I take the same approach when someone has a history of suicidal thoughts or manic episodes. Planning for the “What if?” is crucial.

Shame is one of the strongest drivers of continued use after a slip. When people feel terrible about themselves, they tend to use more, not less. A plan made in advance, when you’re clear-headed and not in crisis, gives you something to reach for when shame is loudest and concrete steps for what to do next. It interrupts the spiral.

Image: Zaleman/Adobe Stock

You Are the One Who Gets to Decide What Happens Next

This is the most important thing I know about slips: they don’t determine the outcome. You do.

A slip is a moment. What comes after that moment is a choice. And not just one choice but a series of them, made minute by minute, hour by hour. Reach out to someone. Remove yourself from the environment. Dispose of what’s left. Go to a meeting. Contact your therapist or sponsor. Drink some water. Take a walk.

None of those things requires you to have not slipped. They only require you to decide, right now, to begin again.

What I’ve found, over and over, is that people who can hold onto that sense of agency, who can say “this happened, and I can choose to end it here” do better. Not because they’re stronger or more disciplined, but because they can push back against shame and they haven’t handed over their power to the slip itself.

Self-Compassion Is Not the Same as Making Excuses

I want to address something I hear often, usually from patients who are the highest-achieving and the hardest on themselves: “If I’m too easy on myself, won’t I just do it again?”

No. The opposite is true. Shame and self-criticism don’t protect against future use. They fuel it. Self-compassion isn’t about minimizing what happened or pretending it doesn’t matter. It’s about treating yourself with the same basic decency you’d extend to a close friend who was struggling.

If a friend called you after a slip, you wouldn’t say, “Well, I guess you’re just a failure.” You’d say, “I’m glad you called. Let’s figure out what to do next.”

A Slip Is a Signal, Not a Sentence

In its simplest form, a slip tells you something about your recovery plan. Something wasn’t working. A trigger you hadn’t identified, a gap in your support system, a stressor that overwhelmed your usual coping strategies. That information is useful. It’s not a verdict on who you are.

When I work through a slip with a patient, we ask the same questions that are in my handout: What led up to it? What was happening emotionally? Who wasn’t in the loop? What can we adjust? The goal isn’t self-flagellation. It’s understanding. Because understanding is what actually prevents the next one.

Fall Down Seven Times, Stand Up Eight

This Japanese proverb captures something that all the clinical language in the world doesn’t quite touch.

Recovery isn’t a straight line. It never was. The measure of it isn’t whether you fall. It’s whether you get back up. And then again. And then again.

Slips happen. They happen to people with years of non-use. They happen to people who are doing everything right. They happen because addiction is a chronic disease, not a character flaw, and chronic diseases don’t always cooperate.

What I want every patient to know is that a slip does not get to write the rest of your story. You do.

*

I used AI as a writing tool to help organize and refine my thoughts for this post. I came to it with the clinical experience, the opinions, and the handout referenced. The ideas, perspective, and voice are entirely my own.

Layne A. Gritti, DO is a psychiatrist specializing in adult, addiction, and perinatal psychiatry at Sweetgrass Psychiatry.