Thursday, January 15, 2009


Many patients have asked me if I could tell them why so many people relapse. They often quote friends in AA who subscribe to the philosophy that relapse is part of addiction. After so many years in this field, I am reluctant to support that idea. My personal experience tells me that we can change external behaviors. We can encourage and support those who stop participating in negative actions. We can teach patients about triggers, urges and cravings and the journey towards relapse prevention. But the data demonstrates that most will relapse. Why?
My theory is that each person with an addiction has a core issue - usually emerging in childhood and unresolved. It could be abandonment, abuse of some sort, neglect, punishment, gender struggles or a host of other traumas that children are subjected to. Only the person him or herself can identify that issue. Until they recognize and acknowledge that issue and make a conscious effort to deal with it in some therapetic way, they will fall back on what they know - drinking, drugging, gambling or other addictive behaviors. We can put a bandaid on a deep cut and it will heal from the outside. Or we can debris the cut and then bandage it and it will heal from the inside out. Clean up the core issue and the healing will begin.


Rumpole said...

Dr. McGowan,
I agree with your general assessment. But don't you think that with the ever increasing economic woes society now faces, even the strongest of "will" can be compromised? For someone who is 'fighting' an addiction, these times can pose more than just a "pot-hole" don't you think it can be a primary trigger? An escape from reality, an escape from the fears?

Dr. Alicen said...

Thank you Rumpole, for your interesting perspective. What we know from past studies is that 'will power' only lasts about six weeks on its own when it comes to stopping any addictive behaviors. Folks who are using drugs/alcohol to escape the economic realities will be more miserable than ever. They have not learned to use other tools to deal with a crisis. Wellness is achieved by identifyng issues that are triggers and dealig with them in a therapeutic way. Relaxation therapy, exercise and support groups ad spirituality really help. Be well! Dr.M

Board Forum Blogger said...

Hi Dr Alicen

I run a forum for people who are addicted to marijuana and hear all kinds of reasons why people use, what I do agree with you on and what I always advise is to try to treat the underlying problem, otherwise you are just papering over the cracks. There are however certain stresses and problems that are unavoidable and in these instances people do have to learn to develop better coping mechanisms for dealing with them. I always advise and I know it’s not for everybody, but if you can master yoga, meditation, self hypnosis or any other type of relaxation exercise, they are really useful tools for helping you cope.

David Walters

Marijuana Addiction Forum

Dr. Alicen said...

Dear David,
Thanks for the meaningful comment. I totally agree that folks smoke marijuana for a variety of reasons, sometimes just because they want to fit in or socialize. But the daily smoker or person who is dependent, more often than not, has an underlying issue that they either have not identified or do not want to deal with. Research shows that exercise is especially helpful as a coping mechanism by raising endorphins and alleviating depression. It also fills otherwise 'empty time'. Relaxation therapy has its own rewards for all of us. As for yoga and meditation, they are at the top of my list with swimming and running- for those who can get beyond the cold weather.
If you have a moment, please send me your forum site and I will attach it to mine.
Many thanks,
Dr. M