Ambivalence is at the core of addiction (Shaffer, 1997). Those who are addicted and thinking about change want to free themselves from their addiction. At the same time, they crave the satisfactions that their addiction provides. As they become aware of the harm their addiction is doing, they begin to say that they want to quit. Of course, wishing or expressing a desire to quit a behavior is not the same as doing it. Despite the obvious harmful consequences, people in the throes of addiction cling to the part of the experience that they like: the part that was adaptive originally and may have even produced positive consequences, such as relief from painful emotions (Khantzian et al., 1990). The key to change comes when those addicted begin to realize that the costs of their addiction exceed the benefits, as when pathological gamblers identify gambling as a destructive agent in their life. It is at this point that addicted people often ask those who they trust to help them stop, and they take the first steps to seek professional help. This turning point is but the first step of a complex dynamic process, including the possibility that bouts of abstinence and relapse may occur for some time (Marlatt and Gordon, 1985).

Preventing Relapse

A challenge in the treatment of pathological gambling is preventing relapse. For example, few people who stop using drugs remain abstinent thereafter. Marlatt and Gordon examined how slips, that is, single episodes of drug use, can lead to a full-blown relapse (Marlatt and Gordon, 1985). Many personal and environmental factors interact to influence the risk of relapse for any individual trying to recover from an addiction. Successful recovery also involves the development of new skills and lifestyle patterns that promote positive patterns of behavior. The integration of these behaviors into day-to-day activities is the essence of relapse prevention (Brownell et al., 1986). Successful quitters substitute a variety of behavior patterns for their old drug-using lifestyle. For example, many take up some form of exercise. Spiritual conversions sustain others. In some patients, new behavior can become excessive, almost another addiction. We do not know whether the same substitute behaviors occur in pathological gamblers determined to quit.



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