Relapse revisited: a critique of current concepts and clinical practice in the management of alcohol problems.

How a problem is understood dictates how it is responded to. In this paper the problem of relapse and alcohol dependence is reconsidered. The existing major relapse paradigm is evaluated against the last two decades of research. It is concluded that the available research strongly questions the notion that relapse is an addiction-specific event. Instead, relapse is probably better understood as a complex, generic, human behaviour, undertaken at times by all of us. Given this, it is possible that mainstream psychological theories, such as decision making and attribution theory, are important in coming to any understanding of the phenomenon of relapse. It is also contended that the investigation of relapse is potentially an error of focus. Such study invites the investigation of those who do not succeed in changing behaviour, as against the study of those who do. For those concerned with the treatment of alcohol dependence, studying the successes may be a more informative process than studying the putative failures. Given the burgeoning of research over the past two decades the impact on treatment practice is reviewed. It is concluded that relapse prevention and management is very much on the alcohol-intervention agenda. However, the research evidence to date is consistent with the general psychotherapy literature in that doing something appears better than no intervention, but that an optimum, effective, intervention has yet to be devised.