Addiction is commonly recognized today as a chronic disease, with treatment offering not a one-time cure, but the tools for recovery. About 10 to 20 percent of chemically dependent patients are successful at remaining abstinent the first time they come for treatment; others find the struggle always a bit more than they can handle. All must learn to deal successfully with the feelings, the situations and the environments that threaten to pull them back into the abyss. This is the area known as relapse prevention, a vital part of any effective addiction treatment program.

What Constitutes Relapse?
The traditional definition of relapse is strict because, in the view of most professionals, a recovering alcoholic can no longer safely drink in moderation. Too often in the past, however, the recovering individual would let one slip destroy an entire program. “After I had that first drink, I knew I had failed,” said Jamie. His three-week binge might have been avoided had he thought of that first drink as a warning rather than a sign of failure.

Most addiction therapists today are careful to distinguish between the occasional lapse and the full-blown relapse to dependent behavior. “For many individuals,” one therapist said, “the lapse or relapse can be an effective teaching tool. Even if there’s a temporary setback, it can be a positive step toward recovery if something new is learned or experienced.”

Terence Gorski, who has contributed important concepts to the field of relapse prevention, places recovering alcoholics into three general categories:  1.) those who are abstinent; 2.) those who suffer a short-term, low-consequence relapse; and 3.) those who fall back into long-term, high-consequence dependent behavior.  What’s important is not how much of the substance is consumed, but what consequences the relapse has on a person’s lifestyle.

What Leads To Relapse?
Generally speaking, the more severe the drug dependency and the more damage it caused in the past, the greater the danger of a serious relapse. The person who used heavily in the past will have a powerfully conditioned response to many cues in the environment--a birthday celebration, a night out with friends or even a drive down the street where the drug was once obtained. The patient must be taught to understand these situations, to recognize them and to manage them successfully. Some studies are investigating ways of altering the response--either conditioning the patient to react negatively to the cue or to compensate with another action.

Even more important than these cues in the environment, are the triggers within the individual. Most recovering persons will feel a relapse coming for days or weeks--what AA members refer to as a “dry drunk.” Again, the patient must learn to identify symptoms early enough to interrupt and reverse the relapse process. Drugs and alcohol are powerful reinforcers in themselves; they are even more seductive when they are used to relieve tension, anxiety, depression or low self-esteem. Stress is a leading cause of relapse, and therapists note that recovering individuals generally have a difficult time managing stress. To control stress, treatment plans may prescribe daily exercise plus a high-protein, low-sugar, low-caffeine diet. Many recovering individuals have found help through transcendental meditation or through the non-sectarian spirituality of AA. The social interaction of a support group offers a chance to vent feelings of anxiety or frustration. 
(Fred McTaggart, Ph.D.)

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