Miller W R
Center on Alcoholism, Substance Abuse and Addictions (CASAA), University of New Mexico, Albuquerque 87131, USA.
Addiction. 1996 Dec;91 Suppl:S15-27.
Binary thinking has often guided research and practice in the addiction field. For example, emphasis has been given to identifying whether an individual is "alcoholic" or not, and the dichotomous judgement that a client is either drinking or abstinent has been used to judge treatment effectiveness. Research on the nature of alcohol problems, however, indicates that they lie along several modestly interrelated continuous dimensions of severity, rather than occurring as a single syndrome qualitatively distinct from normality. Similarly, changes in addictive behaviors in general, and treatment outcomes in particular, are complex phenomena not readily captured by dichotomous classification. The term "relapse" is itself seriously problematic in various ways, and its definition elusive. It represents a somewhat arbitrary binary judgement imposed on the flow of behavior, and carries negative evaluative overtones. A potentially detrimental abstinence violation effect is implicit in the very use of the term "relapse", which thereby may become a self-fulfilling prophecy. Further, it implicitly pathologizes what is in fact a rather common event in the course of behavior change, and embodies an unrealistic and inaccurate conception of how successful change occurs over time. For these reasons, it may be useful in research and clinical practice to abandon the notion of "relapse" and focus instead on terminology that better describes the normal resolution process for addictive behaviors.
