General points on chronic relapse:
Relapse is when a disease returns after the person has recovered entirely. In AA, this is exceptionally rare, in my experience. Almost all ‘relapse’ is really the continuation of the disease because treatment has not been completed or the spiritual life, once treatment was completed, was not adopted, which means a renunciation of ordinary values and the adoption of spiritual values in their place. Once a relapse has started, it tends to continue, until ‘it’ lets go: we know of no programme that can arrest a relapse once it has started. ‘Chronic relapse’, if it means anything at all, means a relapse that lasts a long time. It would be best to refer to such as a ‘protracted relapse’ to avoid confusion.
When the term is used at all in recovery, it typically refers to a period with sharp, frequent alternations between sobriety and drunkenness, between using and not using. The individual will refer to each episode as a ‘relapse’, saying, ‘I’m three days back from a relapse’, when they’ve been, say, drinking on and off for three years or twenty years. The relapse was not interrupted by the short period of sobriety—it merely underwent a lull, a breather; the person did not recover in between, so this is not a relapse but a continuation—the gorilla woke up from its beauty nap; the relapse happened, in this scenario, three or twenty years ago, not last week; it’s also uncertain whether the person is genuinely ‘back’ from the relapse—they may just be the latest in a sequence of lulls and they may be visiting meetings to alleviate guilt or for many other reasons: the perverse enjoyment of the march of shame to pick up the white chip and the riotous applause. This was my experience in my first three years of getting sober. However, I never relapsed because I had never got well. I simply drank periodically because I was unwell. When I did actually start to do the programme properly, I stopped talking about how many days I had, because the show was over, I meant business, and I did not want to jinx it. I left the ranks of the slippers and joined the ranks of the recovering and recovered.
Drinking again is not necessary, and relapse is not necessary. Both are chosen indirectly by a failure to adopt or maintain the simple programme.
As to cause:
Untreated alcoholics drink. Same with other addictions. There’s a solution. It’s the programme as set out in the Big Book. Do everything in there, give your life to God, fill your life with service and sponsoring others, and there won’t be a problem that is not swiftly solved.
On the question of relapsing in multiple areas:
Of course. If one is going to relapse, one might as well go for it! But one fellowship, whose principles are adhered to rigorously, is broadly sufficient. In early days, one or two more may be necessary for a while to crack Step One and the basics of abstinence. Yet, in terms of bigger picture, as the Book says, ‘Quite as important was the discovery that spiritual principles would solve all my problems.’ All fellowships are vestibules that give onto the same great hall. Multiple fellowships can sometimes mean multiple vestibules and no hall. Some meetings, literature, and fellowship in other twelve-step fellowships can be useful even in the long term, but one must not split oneself between different fellowships, because everything then falls between the cracks. One sponsor. One recovery. ‘One ring to rule them all.’
When I’ve been acting out, it’s because I’ve not been serving God. There’s no mystery here.
I have a dual diagnosis, as well: selfishness and self-centeredness. These are treated with a common solution: the solution of Alcoholics Anonymous. This also works for Al-Anons. Same dual diagnosis; marginally more sophistication in the manifestation. This also works for other more obvious addictions (food, gambling, etc.) All of the interpersonal ‘additions’ or ‘avoidances’ are more about relying on self and others rather than God. When I became a servant of God, my relationships cleared up: all of them.