Relapsing: The Vicious Cycle

Recovery programs have long promoted the "disease model" of alcoholism--the idea that some people have a medical condition that does not allow them to drink without losing control. One alcohol-abuse expert has found that belief in this model may actually hamper efforts to quit drinking.

William Miller, Ph.D., professor of psychology at the University of New Mexico and a researcher at its Center on Alcoholism, Substance Abuse, and Addictions (CASAA), studied 122 people enrolled in the center to find out what predicted relapse into alcohol use. Negative mood, intense and frequent cravings, and lack of motivation to change all qualified--but one of the strongest predictors was whether people thought of alcoholism as an illness.

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It may not be belief in the disease model that causes relapse, says Miller, but the reverse: people who find abstinence difficult to maintain may take comfort in attributing their lapses to an illness they can't control. Although research supports the idea of an inherited vulnerability to alcoholism, Miller contends that the "the disease model, in the way that Americans usually think about it, is not scientifically validated."

At CASAA, excessive drinking is viewed as a learned behavior that can be changed, especially by improving coping and social skills. In Miller's study, for example, the number of negative life events an alcoholic experienced was less important to his prognosis than how he dealt with them: active coping styles and positive thinking were associated with staying sober, while the tendency to avoid or ignore problems was linked to a return to the bottle.

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