Dr. Silkworth On Relapse

In January 1933, Bob Smith attended a lecture by Frank Buchman, the founder of the Oxford Group. For the next two years he and Smith attended local meetings of the group in an effort to solve his alcoholism, but recovery eluded him until he met Bill Wilson on May 12, 1935. Wilson was an alcoholic who had learned how to stay sober, thus far only for some limited amounts of time, through the Oxford Group in New York, and was close to discovering long-term sobriety by helping other alcoholics. Wilson was in Akron on business that had proven unsuccessful and he was in fear of relapsing. Recognizing the danger, he made inquiries about any local alcoholics he could talk to and was referred to Smith by Henrietta Seiberling, one of the leaders of the Akron Oxford Group. After talking to Wilson, Smith stopped drinking and invited Wilson to stay at his home. He relapsed almost a month later while attending a professional convention in Atlantic City. Returning to Akron on June 9, he was given a few drinks by Wilson to avoid delirium tremens. He drank one beer the next morning to settle his nerves so he could perform an operation, which proved to be the last alcoholic drink he would ever have. The date, June 10, 1935, is celebrated as the anniversary of the founding of Alcoholics Anonymous.

In other words, it is not without reason that 12-step meetings are often suggested as a part of any suitable relapse prevention plan. We may stay sober for some time on our own, but isolation will inevitably get us nowhere.

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Subjects addressed by a physician can include medical complications of drugs, relapse prevention, process addictions, the importance of good sleeping habits, and the hazards of sexually transmitted infections.

On the other hand, many people go through addiction treatment without medication over and over again without success. Frequent relapse increases the likelihood of overdose. If you gain sobriety for a certain amount of time, you might take a dose that you are no longer tolerant to and overdose.

Twelve-step programs have historically emphasized complete sobriety, with good reason. It has always been the best option in dealing with addiction. Plus, it remains the best option to this day and should be the first response in most cases. However, is there room for compromise in cases where a person is a frequent relapser, whose disease of addiction seems to resist traditional evidence-based treatment methods? Should practitioners of the 12-step model examine their commitment to non-medicated abstinence?

Though many people can go through addiction treatment and achieve lasting sobriety without the use of replacement medications like suboxone, it is a viable option for people who suffer from chronic relapses.

sedative drugs that act on the brain exactly like alcohol, such as benzodiazepines (diazepam, lorazepam, nitrazepam, bromezepam, alprazolam etc.); and z- drugs (zopiclone, zolpidem and zaleplon). Commonly used drugs such as Gravol (for nausea or sleep) and Benadryl (sedating anti-histamine) have a depressant effect on the brain that affects the reward, motivation, memory and related circuitry. Hence, it is important for people in recovery to only take the non-sedating anti-histamines such as Claritin and Reactine. Pain medications (opioids) such as codeine, morphine, oxycodone, hydromorphone; marijuana and other hallucinogens; and stimulants such as amphetamines (including prescription Ritalin or Adderall) and cocaine. Nicotine is a stimulant as well, hence, it is not surprising that people who quit smoking in recovery also decrease their risk for relapse! Caffeine is a weak stimulant as well that can interfere with recovery because of its effects on the brain.

The "Relapse Is OK" Crowd. The fact is that, with the word "relapse" added to make things sound OK, the "no cure -- treatment -- relapse" disorder became a sump-hole for millions upon millions of dollars in public and private expenditures. And it still is. Consider the following statement in a recent U.S. government pamphlet:

Addiction is a progressive, chronic, primary, relapsing disorder. It generally involves compulsion, loss of control, and continued use of alcohol and other drugs despite adverse consequences. Addiction, treatment, recovery, and relapse are all dynamic biopsychosocial processes (Mim J. Landry. Overview of Addiction Treatment Effectiveness [Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Revised February, 1997], p. iii).

Many people mistakenly believe that relapse is a sign of treatment failure. Early models of addiction viewed successful treatment and relapse as "all-or-nothing." Today, both treatment and relapse are understood to be dynamic processes. In particular, relapse is viewed as a transitional process from abstinence to active addiction. The relapse process consists of a series of events and changes in thinking, attitude, behavior -- that may or may not be followed by the use of substances. Even if use resumes, it may not reach the same level of intensity as before treatment -- at least for a while (Landry, Overview of Addiction Treatment Effectiveness, p. 62).

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