Relapsing: The Vicious Cycle

Viewing alcoholism as a diseasemay contribute to relapse.

By Annie Murphy Paul, published on January 1, 1998 - last reviewed on August 18, 2004

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.

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.