Addiction is often affectionately or ominously described as a chronic, relapsing condition – something like a peptic ulcer or arthritis except a bit more dangerous. The problem with this description is that it is both inaccurate and irresponsible and in the hands of any self-serving addict, it simply invites a relapse. “I have a relapsing condition and that is why I have relapsed, in case anyone is looking for an explanation of my relapse.” With this descriptor, relapse just becomes a self-fulfilling prophecy driven by circular logic.
Addiction certainly appears to have the features of a chronic condition in the sense that when activated by a return to substance use, it often returns from its dormant state of remission with the previous ferocity.
It is a question that I have pondered for many years – why someone who has suffered through the nightmare of active addiction , who then may have had the insights and partial resolution of the problem afforded by some intervention like a treatment programme or the 12 step fellowship, followed then by a period enjoying some of the benefits of sobriety and recovery, when this person decides to return to substance use, even just to test the waters – why this person, who is both forewarned and forearmed more than most people, often ends up back in treatment or worse. One would think that such a person, more so than your average mortal, is tuned in to the potential dangers of substance use and therefore any return to substance use would be with caution and vigilance. Yet, the underlying chronicity of impaired control or “powerlessness’ often kicks right back in with vengeance. Unlike a broken leg or flu, which is an acute problem – once it is treated, it is over, the underlying vulnerability of addiction seems to stay with the addict long after the active phase of the condition has passed. That is it’s chronicity.
What is a misnomer is the idea that addiction is a relapsing condition. This moniker needs to be abandoned forever. Relapse is always a choice, never an inevitability or a mistake or a chance event. If our patients are to recover and find sustainable recovery, then a relapse has to be framed as a conscious choice and usually followed by adverse consequences driven by the underlying powerlessness. Any other understanding of a relapse does the addict a therapeutic disservice. Responsible addiction treatment always refers to the condition as a chronic problem and some people choose to relapse.