Understanding Relapse: A Common Symptom of the Chronic Disease of Alcoholism and Addiction

Relapse is a common characteristic of the chronic disease of addiction.

When we hide a relapse because of shame or fear of what others think—or on the other hand, when we discredit someone else who has relapsed—we set up conditions that perpetuate addiction. Seeking help for relapse is to be praised, not shamed.

A new paradigm in the treatment of addiction has emerged since the 1990s. Thanks to growing evidence from a number of addiction clinicians and researchers—including Dr. A. Thomas McLellan at the Treatment Research Institute and the late Dr. Alan Marlatt, former director of the Addictive Behaviors Institute—we now view relapse in addiction in the same light as relapse in other chronic illnesses. But this hasn’t always been the case.

For too many years we viewed addiction as though it should respond to treatment like any acute illness or injury should. For example, if you broke your leg and the medical doctor set it properly, the leg would heal and you would eventually recover your ability to walk and run. Or if you had pneumonia and were treated with an antibiotic, you were expected to fully recover.

Simply stated, the recovery model for addiction was based on the notion that if you completed treatment, and/or went to enough AA or NA meetings and followed directions, you shouldn’t relapse; you should stay sober for life. If you did relapse, that meant you were doing something wrong, and it was your “fault.” Many addiction professionals and AA and NA members alike naively applied this model to recovery from addiction because they didn’t fully understand how radically addiction hijacks a person’s brain.

It’s well documented that only about 20 percent of those patients who receive treatment or go to AA (or other Twelve Step–based mutual help groups) remain sober for the first year of their recovery. Eighty percent experience a relapse. That means four of every five people will relapse in their first year of recovery.

This data could be shocking and demoralizing for those who don’t understand the typical course of treatment for a person suffering from a chronic illness.

Medical doctors who deal with chronic illness understand that the patient will suffer many setbacks. These are not considered treatment failures; they’re considered intrinsic to the nature of most chronic illnesses.