How Not to Relapse - OZY | A Modern Media Company

How Not to Relapse

How Not to Relapse

By Meghan Walsh

Welfare hotel residents are photographed smoking crack May 20, 1986 New York City.
SourceYvonne Hemsey/Getty


Because addiction is expensive for all of us, and conventional wisdom hasn’t worked. 

By Meghan Walsh

We all know that overcoming drug addiction is terrifically difficult. And unlike the many things from the ’70s that have changed since, from bell-bottoms and disco to Archie Bunker, the relapse rate of addicts has stayed about the same — about 40 to 60 percent of all addicts relapse within a year. In other words, the odds of relapsing are up there with that of a coin toss. 

But three groups are faring a little better: pilots, doctors and lawyers. Their relapse rates are as low as

10 to 25 percent.

Sure, you’re not falling-on-your-face shocked that this demographic is better off than a lot of folks. But that’s a difference of nearly threefold. It makes you wonder what exactly is working so well for pilots, doctors and lawyers.

Treatment of addiction, of course, is not a 20th century phenomenon. (As far back as the 1750s, American Indians were getting help through mutual aid societies. Almost a century later, the first “inebriate asylums” were being established.) People have a tendency to think of addiction as an issue of character — thin moral fabric, a shoddy upbringing or poor lifestyle choices. “It’s repulsive to them to think a person who willfully injected heroin into their arm is similar to a person with epilepsy,” says A. Thomas McLellan, Ph.D., co-founder of the Treatment Research Institute in Philadelphia. So treatment for addicts has historically been more punitive than compassionate, with only brief stints in rehab recommended. 

But many experts say addiction should be handled like a chronic medical condition, with comprehensive, long-term treatment that includes not just medication, but also lifestyle changes and ongoing monitoring. Research has shown that when it comes to heritability, pathophysiology and response to treatment, chemical dependence runs parallel to diagnoses like diabetes, hypertension and asthma, which all have similar relapse rates. With those illnesses, doctors don’t hospitalize patients until, say, their blood sugar stabilizes and then simply release them.

So here’s what people with better relapse rates are generally getting: a long-term, comprehensive approach with a lengthy period of residential treatment (often up to 90 days), followed by outpatient care that includes psychotherapy, both one-on-one and in a group setting, as well as any necessary pharmaceuticals — and, crucially, follow-up care.

Some experts, such as Dr. Lance Dodes, don’t agree with the comparison of addiction to chronic medical conditions. Dodes, a retired assistant professor of psychiatry at Harvard Medical School, says addiction is nothing more than a psychological symptom and that the substance abuse is just an expression of compulsive behavior. “Once you work out the cause of it, the addiction goes away,” he says.

McLellan argues that if that were true, addiction treatment would generally be more successful. Still, he warns, the chronic-illness angle isn’t a silver bullet — it’s going to take time to see results. Because addiction hasn’t been integrated into general medicine, doctors don’t screen for it, much less have a clue how to treat it, which also comes back to the stigma of addiction. But, he says, viewpoints are shifting toward approaching addiction as a chronic illness. “All the forces seem to be gathering.”

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