Substance Abuse Relapse
As we have seen, the statement "once an addict always an addict"
is a lie and a curse. Most of those addicted to various substances do change.
Even if they relapse and are unable to break the habit completely, they may
reduce the level of substance abuse. Indeed, if you follow up a large number
of young adults addicted to various substances, significant numbers will no
longer be using them ten or twenty years later.
A basic type of relapse is the post-treatment return to use of a specific substance
(e.g., cocaine) that was used before treatment. A second type of relapse is
the non-medical use of a drug to substitute for a principal pretreatment drug
(e.g., other narcotics as a substitute for heroin). A more comprehensive definition
of relapse is the post-treatment resumption of the pretreatment pattern of substance
abuse (e.g., multiple use of heroin, cocaine, marijuana, and alcohol) or the
development of new patterns of use.
From the treatment perspective, substance abuse relapse is a key issues. The
high rate of substance abuse relapse is an especially frustrating problem, and
the notion of a "cure" remains elusive. Substance abuse careers are
episodic, with periods of abstinence, reduction of use, and relapse the prevailing
pattern. Often times, the course of events are influenced by external factors
such as the availability of drugs and societal pressures. Given the patterns
of relapse, a variety of interpretations of how substance abuse should be treated,
and what the goals of treatment should be, have evolved.
High relapse rates among substance abusers remain old news. Numerous studies
have documented that high relapse rates prevail across classes of substances.
For example, Marlatt (1979) has found that the average time from abstinence
to relapse varies from 4 to 32 days for tobacco, alcohol, and opiates.
During the 1950's, it was often asserted that few individuals ever recovered
from substance abuse. Then, in the 196O's, Winick (1962, 1964) produced data
suggesting that approximately two-thirds of narcotic addicts mature out of their
addiction in their thirties. Subsequent long-term follow-up studies have pointed
to a truth somewhere between these two extremes of pessimism and optimism.