WHY ADDICTS OFTEN RELAPSE

Addiction has been described as a clinging, clawing monkey that shrieks
incessantly and is attached like an appendage to a drug user's back.

And it never completely goes away.

"The tug is always there," said Jim, a recovering alcoholic who has been
sober for 15 years and asked that only his first name be used. "As many of
us say, I know I have one more drunk in me, but I don't know if I have one
more recovery."

While some may be puzzled by the highly publicized on-again-off-again
attempts of actor Robert Downey Jr. to overcome his drug problems, those
who understand addiction say his experience is fairly common. Some even say
relapse is part of the recovery process.

"There is no straight line between addiction and recovery," said Ralph
Tarter, professor of pharmaceutical science and psychiatry at the
University of Pittsburgh. "We hope for that, but often it is an uncertain
pathway."

In fact, a series of lapses is not at all unusual, he said. "The issue is,
stick with it."

That's good advice, said Jack Kent, coordinator for the Drug Court program
at Project BLANKET, a nonprofit agency that helps Pittsburgh-area inmates
kick addictions.

A recovering drug addict and alcoholic himself, Kent said it sometimes
takes drug users years to understand that emotional pain is often at the
heart of their addictions. In 12-step recovery programs, they learn how to
talk about, rather than hide, the searing pain they have tried to
anesthetize with drugs.

Like Downey himself, who has managed to keep working in films and TV during
his addiction, Kent was a high-functioning addict who used heroin, crack
cocaine, marijuana and alcohol for more than 30 years, all while working
regularly. He once held down a job counseling juvenile offenders against
drug abuse, while simultaneously using drugs himself.

Disgusted by the hypocrisy, Kent quit his job. He began using more drugs
and ended up broke and lost his home and his girlfriend. Finally, believing
it was time to quit, Kent entered a rehabilitation program.

There, he learned that he was using drugs partly to dull childhood
memories, including those of beatings he and his mother suffered at the
hands of a 6-foot-4-inch, 320-pound stepfather who called him "worthless"
and "stupid."

"What we hide in the darkness has power over us," he said. "We have to
bring it into the light in order to heal, and in rehabilitation we learn
how to do that."

But it's not necessarily a smooth road.

Days out of rehabilitation, Kent had a fight with his former girlfriend
over whether to return some of his belongings. Feeling hurt and rejected,
Kent sought solace in alcohol and crack cocaine. While high, he broke into
her apartment to retrieve his things and was arrested.

It was midwinter when Project BLANKET's director, the Rev. Marcus Harvey,
found Kent in jail. Kent was about to be released wearing the T-shirt and
shorts he had been wearing when he was jailed the previous summer.

"Rev. Harvey looked at me and he said, 'You're an addict. You can't do this
by yourself.' And bam! His words hit me like a hammer, and I knew he was
telling me the truth," Kent said.

Harvey provided Kent with clothes, a place to stay and fellowship with
other recovering addicts, which the men say is extremely important to a
successful recovery.

While support from others is essential, it is not the only factor in
overcoming a drug habit.

Recovery, like addiction, is complicated. Many things are involved, such as
an addict's genetics, environment, treatment, personal support system,
whether he has a secondary psychiatric diagnosis, the addictive substance
itself and the duration of addiction, Tarter said.

"Even the definition of relapse is not precise," Tarter said. Experts often
distinguish between a lapse, when a recovering addict uses the drug once
but then returns to abstinence, and a relapse, defined as a return to drug
abuse at a level that causes problems.

Most important is that the recovering addict and his family not view a
lapse as failure and the future as hopeless. If they do, the addict is more
likely to resume chronic abuse, he said.

While lapses may be common, professionals who work with addiction are
reluctant to cite figures. Not even the Center for Substance Abuse
Prevention, which collects data for the federal government, has relapse
numbers.

"We don't look at it like that," a spokeswoman said. "People seem to think
drug abuse recovery is like fixing a broken bone, but it's not. It's a
chronic disease, like diabetes and heart disease. No one asks how often a
heart patient has to be hospitalized."

But one review conducted by National Institute of Drug Abuse researchers
provides some insight. Dennis Daley, associate professor of psychiatry at
the University of Pittsburgh, said researchers reviewed 100 treatment
programs and found that after one year, 40 to 60 percent of the recovering
addicts had been continuously abstinent, while 15 to 30 percent had made
significant improvements in

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