A client asked me recently about something he’d heard on NPR, that there are medications which can cure alcoholism. I listened to the podcast, and indeed they made it sound that way – and implied that there’s some conspiracy to keep people from obtaining these meds. That’s simply not true.
Most of the alcoholism treatment programs I’m familiar with have been using certain medications to support treatment and recovery for decades. But alcoholism is extremely complicated, and there simply is no one-size-fits-all treatment. Some medications help some of the people some of the time, but just like drugs for depression, people often have to try many different ones, and in different combinations (while they also abstain from alcohol) before they find something that brings relief without unpleasant side effects. I’ve had clients who have tried all of these meds without lasting success. I’ve also seen remarkable recovery (which is not the same as a cure).
Gabrielle Glaser, who was interviewed in this podcast and wrote an article in The Atlantic magazine on this topic this last spring (May 2015), is a journalist looking for a story, not an addiction researcher or clinician. I read her article, and there were some interesting points, but I don’t think she gives an accurate view of the addiction treatment field.
I’ve worked in traditional treatment settings, employee assistance programs, and as a substance abuse professional evaluator. I try to keep current on the latest treatment methods by reading, and attending conferences. My perspective on addiction is also informed by what I’ve learned from my clients over the last 25 years, and my personal experience (I am a person in long-term recovery – from growing up in a dysfunctional family, which led to unhealthy relationships with substances and people). Here’s what I’ve learned about treating alcoholism and other addictions:
All addictions begin with the basic human desire to pursue pleasure and avoid pain. Our brains are wired to reinforce experiences and substances that we associate with pleasure, and/or the removal of pain. Normally, this helps us survive, but for some susceptible individuals, the addiction process takes over – overriding instinct, as well as common sense, good judgment, moral beliefs, and family values. I don’t know if this is a disease, but it’s definitely not a choice.
The addiction process can be interrupted, slowed, and even stopped, through a combination of abstinence and treatment, but not cured. So treatment success means “staying stopped,” which is the hard part. The traditional treatment program or “rehab” is 28-30 days – an arbitrary number which has little to do with how long it takes to completely clear the body and mind of a particular substance, or how much education and counseling people need to transform addictive behaviors into healthier habits, but is often the limit of what health insurance will pay.
People come out of a month-long rehab program not “cured,” but the opposite: raw, unprocessed. I’ve had many clients describe feeling like an infant: small, helpless, a squirming bundle of needs and feelings they can’t put into words and which they’re at a loss to know how to handle. And yet their families, employers, and communities expect them to be able to jump right back into their overscheduled, stressful lives – and not only that, but to be even better people: more considerate, more engaged, more productive, as if they must make up for lost time and compensate for all of the damage done while they were caught up in their addiction. Is it any wonder so many treatment graduates relapse, and resume drinking or using within a few months?
We need to place less emphasis on treatment and more on recovery (or what happens on day 31, and every day after that for the rest of your life). Treatment is just the beginning, a time to detox the body, clear the mind, and learn a little about the science of addiction. It can also be an opportunity for people to start being honest with themselves and others, and to develop some tools to deal with negative emotions and cravings. Employers and health insurance plans who cover treatment should also fund and support participation in on-going recovery and relapse prevention programs. And families of alcoholics and addicts need more education about what is realistic to expect in early recovery, especially in the first year.
While relapses can be expected, we can do better with relapse prevention programs. If we accept that alcoholism and addiction are relapsing diseases without a cure, then we need to offer more options for supporting healthy recovery, besides AA and the other 12-Step programs (which are wonderful programs that simply don’t work for everyone). These options may include 1) using medication to help reduce cravings; 2) teaching “harm reduction” strategies to reduce use and limit the negative consequences of relapse; 3) promoting mind-body practices like meditation and yoga to reduce reactivity; and 4) individual therapy to address unresolved trauma or other personal stressors. And my personal favorite: Mindfulness-Based Relapse Prevention!