When Rehab Is a Revolving Door: What to Do When Alcohol Treatment Doesn’t Work

A brief review on the incidence of relapse in the treatment of drinking problems, with some ideas for how rehabs can target people ABOUT TO RELAPSE…and intervene. Your ideas are welcomed at the end.

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Relapse as a Part of Treatment?

What do most treatment centers do to prevent a relapse? Helping a patient detox from alcohol in a safe and stable environment is one thing; preventing that patient from ever abusing alcohol again is another thing altogether.

It’s an unfortunate and unavoidable truth that many people with an alcohol use disorder do relapse, even when they’ve had the highest quality of treatment. In circumstances like this, it’s essential that alcohol addiction treatments do everything they can to avoid being part of a recovery and relapse cycle.

How Many People Relapse After Rehab?

Relapse is when a person returns to drinking after a period of sobriety. These periods are often short but are sometimes much longer. Sadly, according to the National Institute on Alcohol Abuse and Prevention, roughly 90% of people with alcohol-use disorder relapse within four years of completing treatment.

The numbers do not put alcohol addiction treatment in a positive light. It’s easy to see why many people lose hope of recovering. Worse still, the relapse rate can trigger a vicious cycle. Why should a person go to the trouble of detoxing from alcohol if there’s a 90% chance that they’ll end up relapsing anyway?

It’s important that we reframe these numbers in a more positive light. Though alcohol addiction centres can and should improve, we should also acknowledge the good that is accomplished in the 10% of people who complete a program and stay sober.

Even a short period of sobriety can be a blessing. Though a full recovery is ideal, a one or two-year period of sobriety can be a happy and meaningful part of someone’s life. In that time, a person with an alcohol abuse disorder can make fulfilling emotional, social and professional developments. Ideally, they’d also lay the groundwork for a full recovery.

Should Rehabs Have To Publish Their Relapse Rates?

One proposed solution is legislation mandating that alcohol addiction treatment centres track and publish their relapse rates. Patients would be able to compare high-performing centres to low-performing centres and make the best choice based on results.

The idea is not without merit. If drugs companies must publish the results of their medical trials, why shouldn’t the same reasoning be applied to alcohol addiction centres? Might we be able to improve performance if alcohol addiction treatment centres are held accountable for their results?

It’s also possible to see some unintended consequences of this legislation being implemented poorly. People who relapse are often likely to hide their drinking for fear of disappointing friends and relatives. Would rehab centres always be able to accurately establish who had and who hadn’t relapsed, especially when the patients themselves might have an incentive to mislead interviewers about their progress?

The second potential danger is one that we observe in selective schools obsessed with their grade average. A rehab centre might be incentivised to refuse treating a patient who looks unlikely to make a full recovery as the failure would be a blot on their record. Obviously, a system which can in some cases leave the neediest without support is one that needs work before implementation.

What About Kindling?

So, why is alcohol withdrawal more dangerous the second time around?

A relapse into alcohol misuse is always a tragedy. The patient may feel like their hard work and progress has been a waste of time. Family members who were previously supportive might waver. There’s the danger to health of excessive alcohol consumption, as well as the economic dangers of alcohol abuse.

But there’s also a less publicised factor that makes a relapse dangerous: kindling. It’s widely known that alcohol withdrawal can be dangerous or even fatal. Water-soluble ethanol, one of the chemicals in alcohol that affects the brain, amplifies GABA. GABA is a brain chemical that slows and “relaxes” the brain. This is why drunk people are clumsy and slur their words.

When people with an alcohol dependency suddenly stop drinking, the slowing effects of GABA on the brain stop immediately. This causes the brain to “speed up” at dangerous levels, and it’s this process that can be fatal. One benefit of alcohol addiction treatment centres that is undeniable is the medical supervision. By supervising an alcohol detox, a medical professional can greatly reduce the symptoms and dangers of alcohol withdrawal by prescribing the correct medicine.

Kindling is what happens when a person experiences recovery and relapse a number of times. Each time a person goes through alcohol detox and withdrawal, the symptoms of alcohol withdrawal become more and more severe. A person experiencing alcohol withdrawal for the first time is much less likely to experience seizures than a person going through alcohol withdrawal for the second time. Kindling is another important reason why alcohol addiction centres need to get it right the first time around.

What About the Loss of Hope?

It’s also important that the patient continues to have hope. When a patient recovers from alcohol and then relapses, they’ll often try a new method of recovery. The failure of the first recovery can then be blamed on the “old treatment” which they’ll see as a “bad” way to recover.

This is a mental exercise that can be helpful, even if it isn’t necessarily accurate!

But if a patient recovers via a second method only to relapse again, they might come to the conclusion that they are a lost cause and beyond help. This is a very dangerous negative cycle to be in. People who think that they are beyond help are more likely to drink excessively and are less likely to seriously engage with attempts at recovery.

Breaking the Relapse and Recovery Cycle

What can alcohol addiction centres do to break the cycle of relapse?

The fact that relapse is so common does at least enable us to identify with some clarity the telltale signs that a patient is close to relapsing.

Skipping meetings with sponsors, therapists, or counsellors is one of the biggest warning signs. Another sign is losing interest in healthy hobbies and alternative therapies that were a part of their original recovery. Ignoring or failing to follow an after-care plan is another indicator that a relapse might be imminent.

Therapy, including cognitive behavioural therapy (CBT), is the best weapon that we currently have against relapse. It’s important that a patient is able not only to detox from alcohol but also develop the mental skills needed to resist temptation in the future.

People in recovery should also be able to identify potential triggers and develop coping techniques that will help them overcome their cravings. Good nutrition, exercise (at least 20 minutes of cardio per day), and stress management are key to lifestyle changes. Most importantly, they need to be able to continue to believe in themselves and the possibility of recovery.
Should a patient waver … rehabs may need to develop novel ways to reach out and keep in touch. This is why forward-thinking industry leaders are using:

  • Skype-to-Skype video chats between counselors and patients
  • Mobile apps to track recovery progress
  • Alumni groups for continued support
  • Weekly check-ins or recovery coaches.

What ideas have you come across that you think can work?

Your feedback is welcomed!

Author Bio: Obi Unaka is the Treatment Director at Charterhouse Clinic. He has developed addiction treatment services and led clinical teams within residential, community and criminal justice settings.
About the author
Obi Unaka is the Treatment Director of Charterhouse Clinic Flore, a fully residential, luxurious drug and alcohol rehabilitation, health and wellbeing facility set in the idyllic countryside of Northamptonshire, UK. Obi is a therapist, clinical supervisor, consultant and registered manager with many years experience of working with individuals presenting with problematic substance use and process or behavioral addictions.
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