Problems in late stage alcoholism treatment: Part 3
Late stage alcoholism requires long recovery times
Very long recovery times are the biggest difference for people with advanced alcohol problems. When I entered treatment the wrong diagnosis I received set the tone in all of the programs I had afterward. I was repeatedly told my condition would only take a short number of weeks to clear up and every treatment center I went to said my condition was “common” and that my problems would clear up immediately. It was apparent they evaluated everybody as being “equal” – they said over and over that everyone in treatment was the same, and the goal was to try to standardize treatment and rush people through the programs as quickly as possible. But since every program I went to around the state repeated the same diagnosis I could not understand why my condition would not begin to improve. Each time I achieved several months of sobriety I relapsed again, and it kept happening over and over because of the severity of my condition and because I didn’t realize how long I would need to clear up.
Is mis diagnosis for late stage alcoholics common?
I suffered due to the wrong diagnosis until it was suddenly switched when I was on my way to my last program at Evanston. Then an independent counselor in Casper who was doing the pre-intake evaluation for me to go to Evanston said I would need more time to clear up than I had previously been told. She said it would take up to two years for the condition of my brain to improve, and it was the first I had ever heard about this type of advanced alcoholism at all. I am sure she was able to talk to me about it because of the fact she wasn’t part of the treatment system in the state – she also had been a counselor prior to the Reagan Revolution so that she had witnessed the changes that had taken place in treatment over the years, and I think she was one of the few people around who understood the shortcomings in the treatment system for advanced alcohol patients.
It was truly a shock at that point to find out that I would need such a long time to begin to recover. It was very difficult to imagine being able to start my recovery when I had already failed in three treatment programs and was on my way to the final program in the state at Evanston. I was in very poor condition at that point, and I had many kinds of problems including a lot of legal problems that had happened after I entered treatment. It was very depressing to have developed so many of these problems in such a short period of time. But the main problem was just that I was at a very serious stage with the drinking at that point, and because of the severe relapse (and with everything else that was happening) I remember thinking that I wouldn’t be able to make it back due to the damage I had and the long term recovery I knew I would have to face.
Janet didn’t know why she couldn’t clear up either. She might never have been diagnosed correctly at all. I was able to recover once I knew what the problem was, and overall it took approximately three years to recover from the pills and then the alcohol after I finally quit drinking. It was an extremely hard process, and without the truth I might not have been able to do it. I could not understand it – I thought my situation was ordinary and my problems were no different from anybody else. That was what I was told in treatment. But the condition I had was extraordinary due to the type of damage I had, and my inability to make any progress because of not clearing up during any of the short programs derailed my recovery time after time.
When Janet went off the medications she talked only about the problems from the pills because she was in the middle of the crisis at that time, and I believe she wasn’t really able to comprehend that alcohol was the cause of the problem. She told her family the pills had caused the problems rather than the alcohol, and because of this I think they thought that depression was the main problem rather than alcoholism. I believe she died due to end-stage alcoholism, but I believe the family wasn’t aware of the type of alcoholism she had because the treatment programs misdiagnosed her condition – no one told the family the truth, and they had no information to go on.
It doesn’t say much for the treatment system when her family didn’t even know about the type of alcoholism she had when she died because nobody gave her a diagnosis. They might have been able to help her if they knew. Somebody should have been there to tell them that this type of alcoholism must be dealt with first ahead of other problems – like depression. The focus has to stay on this one issue. It’s obviously very dangerous for doctors or psychiatrists who don’t understand alcohol problems to prescribe drugs for these patients while they are trying to recover from this severe type of alcohol damage. When pills enter the picture for someone who has been misdiagnosed the focus can easily be lost, and in Janet’s case I believe this sort of confusion during the crisis from the pills was made far worse when her family completely misunderstood why the crisis happened in the first place. It became a huge distraction from her recovery, and since the family didn’t have the right information they weren’t able to support her when she had such a huge setback with the nervous breakdown. Their lack of understanding was just one more problem for Janet, and I think her situation became hopeless due to all of the confusion going on. The focus became so obscured I think her condition with the alcohol became extraordinarily illusive for her. Severe alcoholism is just that way. Alcohol problems that reach an illness stage are extremely deceptive for patients AND family members, and for that reason alone giving people with end-stage alcoholism an honest diagnosis is absolutely critical.
The misunderstandings along with the nervous breakdown created an unbearable situation for Janet – her sense of hopelessness increased and she had no support from any direction while she was suffering with this sort of extreme situation. In a real sense she had been permanently cast out of the treatment system when she was forced from the program at Evanston, and her friends and family couldn’t be supportive because they weren’t aware of the severity of the underlying alcohol condition. She was alone with this situation, and AA was not an option while she was in that kind of condition. She had nowhere to turn. Her only hope would have been simple honesty from the programs about the type of medically-based alcohol condition she had, but there was no treatment and no diagnosis for patients like this in Wyoming at the time. The reaction she had from the medications was simply alcohol related while she was at the worst stages of this disease – but the misunderstandings engendered by the system in Wyoming muddied the waters about what was really going on for her, and the diminishing support was the biggest factor in this tragic situation.
Late-stage alcoholism and mental sensitivity
Extreme “mental sensitivity” is the true hallmark of late-stage alcoholism. In some cases this condition goes on for years even after a person quits drinking, and it is the main thing that keeps people out of the recovery groups with their absolutist type attitudes. It is ironic that the failures people suffer when treatment or AA doesn’t work are only seen as “temporary setbacks” by counselors and doctors in the treatment programs. In truth these are major problems that will inevitably lead to disastrous consequences for people who are unable to recover in the system we have – and I believe there have been many tragic outcomes in cases where people have been thrown out of treatment and left to recover on their own.
The legal system dictates alcoholism treatment duration
Recommendations to provide real treatment for people with the worst problems have been forgotten, and today the only programs being done are those that are designed for people who need help the least. For the most part only people who are involved with the courts are allowed into inpatient treatment lasting longer than a month. By the time alcohol patients become involved with the courts their problems are at an advanced stage and it is probably obvious how things will go for them in our legally-based system. Since medically-based programs still aren’t being done the primary diagnosis-type condition these people have will just be misdiagnosed. During a hearing in the last session of the legislature about a bill to change the laws for impaired driving a substance abuse counselor from Jackson Hole told the committee that repeat alcohol offenders are not being evaluated correctly for the problems they are having, and she said that patients are not identified as possibly needing extra attention even after multiple trips to substance abuse programs.
Basically this counselor obviously cared strongly enough about patients to speak out, and she confirmed that the worst afflicted cases receive very little help in our system. There are no programs in the state specifically targeted to help patients who are in the most severe condition, and consolidated treatment programs have permanently taken the place of the long term programs that used to exist specifically for the purpose of working with people who have very extensive recovery issues. Problems with state funded programs for people with legal issues are so bad that people who aren’t forced to be there often won’t stay. That’s the legacy with the treatment we have today. The programs can’t even give a little hope to people who want to recover. They are obviously not up to the task of identifying and treating advanced cases.
Can we change the culture of the alcoholism treatment system?
I think this letter shows that honest information is what is needed for patients to be able to recover from severely advanced alcoholism, but nothing has changed and my friend’s story is as valid today as ever. The denial of these problems is still part of the culture of the treatment system – there is a judgmental mindset that stops counselors from accepting that some patients are different and will need to undergo a true long term recovery process. These people shouldn’t have to wind up in car wrecks or in a hospital with the DT’s, or going out and attempting suicide before their real diagnosis with alcohol is finally acknowledged. But without any treatment specifically for these problems counselors will never understand that there is a significant difference with this sort of damage – and patients will still be intentionally under-diagnosed if programs aren’t allowed for them.
Photo credit: Robert Huffstutter