RELAPSE IS JUST PART OF MANAGING ALCOHOLISM

Mel Gibson's relapse was a public humiliation. Robin Williams, who
"found himself drinking again" after 20 years of sobriety, according
to a statement released last week, had a private one. Both are back
in treatment as some of their legion of followers "tsk-tsk," shake
their heads and conclude that two more stars have failed.

But such relapses are fairly common during the lifelong struggle
against what science considers the chronic disease of alcoholism. A
relapse into renewed drinking, experts say, is no more a treatment
failure than is a second heart attack in a cardiovascular disease patient.

And alcoholics are no worse -- and maybe a bit better -- at
responding to treatment, and sticking to it, than are patients with
other chronic diseases.

"It's not like appendicitis, where they have surgery and it's cured,"
says Dr. Donald Kurth, chief of addiction medicine at Loma Linda
University. "It's more like diabetes. You can manage it, but you have
to work at it every day."

The changing treatment model -- outpatient, instead of inpatient --
further reflects a growing body of science that gives patients and
doctors more choices and more hope that abusive drinkers can eventually change.

William R. Miller, professor of psychology and psychiatry at the
University of New Mexico, has studied addiction for 40 years. He
doesn't even like the word "relapse." "I think it's a pejorative
term," Miller says. "If you think about asthma, we're not surprised
if a person who is treated has an asthma attack. With high blood
pressure, if it becomes elevated, we adjust treatment. We don't shame
them because they've relapsed."

Dr. A. Thomas McLellan looked at three conditions medicine shows can
be managed, but not cured, and compared treatment outcomes with those
for alcohol dependence. The other diseases were high blood pressure,
asthma and diabetes. After a review of studies, published in the Oct.
4, 2000, Journal of the American Medical Association, he found after
treatment for alcoholism, regardless of treatment type, about 40
percent to 60 percent of problem drinkers remained abstinent for at
least a year. Other chronic diseases, including diabetes, asthma and
high blood pressure, have similar or worse relapse rates a year after
medical treatment.

Fewer than 60 percent of asthma and hypertension patients take their
medications as they should, McLellan found, and fewer than 40 percent
of adult diabetes patients adhere to their medication schedules. When
it comes to lifestyle changes, more than 70 percent of patients with
asthma, hypertension or diabetes fall off their prescribed
diet-and-exercise wagon.

Yet doctors continue to treat people whose blood pressure, diabetes
or asthma gets out of control. "We wouldn't tell someone they can't
get treatment because they continued to eat doughnuts," Kurth says.
"We don't scold them, we don't chastise them. We treat them." With
alcoholism, a setback isn't a reason, either, to give up. The
ever-present threat of those setbacks, after all, is precisely why
people in Alcoholics Anonymous call themselves "recovering" not "recovered."

Treating the disease means treating people through their relapses.
The trouble is, while an alcoholic is learning to stop drinking,
every slip contributes to the disease's $185 billion annual cost,
according to the National Institute on Alcohol Abuse and Alcoholism,
in crime, lost productivity and social problems. The personal costs
are just as steep. Drinking distorts reason, and lays waste to
marriages, friendships and careers.

Treatment needs vary, but for the majority of alcoholics, outpatient
treatment has become common -- and in many cases, preferred. The
28-day inpatient treatment programs, such as those at the Betty Ford
Center in Palm Springs, Calif., or Hazelden in Minnesota, were once
considered the gold standard of care. For many, they may still be the
best choice. But even those programs depend on months of follow-up
care, including individual counseling and group programs such as AA.

Of the 700,000 people currently getting treatment for alcohol
dependence on any given day in the United States, 13.5 percent are in
a hospital or residential treatment center, while 86.5 percent are
getting outpatient treatment, the reported choice of Mel Gibson.

"That could be more effective, because you learn how to live in your
community, rather than being off in some resort-type setting," says
Eric Goplerud, director of Ensuring Solutions to Alcohol Problems, a
research center at George Washington University. Intensive outpatient
treatment generally involves three to four hours of one-on-one and
group treatment most days of the week for several weeks. The patient
keeps going to work and continues to live at home.

"One of the supports that people need for staying sober is holding
their job," Goplerud says. "Outpatient treatment allows them to hold
their job and work out the system for staying sober in the context of
their everyday life." While in treatment, they're still dealing with
everyday stresses from a spouse, kids, commuting or the temptation to
drive past a favorite bar.

A strong predictor of who is going to get better, even after
relapsing, Miller says, is that an undeniable message makes its way
through even the worst alcohol fog. Maybe the signal comes when a
spouse leaves. Or when a drinker ends up in court, or lands in jail.
Or when an employer warns that a job is on the line.

Or, in the case of a celebrity, the message that alcohol is messing
up one's life might arrive when humiliating behavior gets plastered
all over newspapers, TV and the Internet.