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Dual Diagnosis - Factors Supporting Recovery from Alcoholism

Posted Oct 03 2008 12:52pm

I’m posting this in the context of the dualdiagnosisthread I’ve been writing, but the suggestions certainly stand for alcoholism absent any other significant mental health disorder. Also, I should point out that I will be writing this in very general terms, based largely on information provided during the conference I attended with Dr. Roger Weiss, with my own thoughts and observations from my years as a drug treatment coordinator added.

Dr. Weiss discussed a few points regarding recovery from alcoholism prior to addressing methods to facilitate recovery. He noted that, neurologically, recovery from alcoholism takes approximately two full years, following heavy use (this doesn't mean full recovery, mind you, just that your brain may take up to two years before it gets back what it's going to get back). Also, as a useful way of describing the recovery process, he stated recovery from alcoholism is like recovery from cancer - five years of sobriety means statistically you’re in good shape, just like five years in remission means you’re in good shape. In general, one of the best predictors of future sobriety is the length of time one has been sober thus far.

Now, onto the factors that support recovery:

1) Increased Hope - this applies to many different problems, but certainly to recovery from alcoholism. It is extremely important that an alcoholic who is considering sobriety truly have hope that a life without alcohol would be better. This seems obvious to people without an addiction, but this is not obvious to an alcoholic. Alcoholics Anonymous will sometimes state that for an alcoholic to get serious about recovery, they need to hit “rock bottom” first. Why would that be? The thinking goes, no matter how bad an alcoholic feels at any given time, a view of a sober lifestyle looks worse. And, frankly, being sober after a lengthy period of alcoholism really does suck for awhile (physically, mentally, etc. - more on that in another post). Only at rock bottom, where one can’t go any lower (this is a matter of perception, of course), will some alcoholics be able to say, “No matter how much sobriety may suck, it can’t be worse than this.” It’s generally impossible to convince people to voluntarily change their life for the worse; many alcoholics see becoming sober in that light, until they hit bottom.

A therapist, friends, family, AA, etc., should do everything possible to increase an individual’s hope for a better future, without promising anything unrealistic. Bottom line - an alcoholic who attempts recovery is most likely going feel significantly worse before they feel better. This needs to be pointed out to everyone entering recovery. Otherwise, they will give up their sobriety at the first sign of discomfort. With alcohol, I’ve warned clients (and Dr. Weiss has also suggested this), it will be at least one month, maybe longer, before you feel any better than you did when you were using. This is why, for some alcoholics, an inpatient unit (or a correctional setting) is the only really effective way of getting treatment - they simply won’t be able to tolerate the discomfort they will feel for that long of a time frame without relapsing, unless physically kept away from the stuff. Unfortunate, but true.

2) New Relationships - Ah, once again, the benefits of social capital! But really, it’s more than that. We don’t just want new relationships, we want different ones as well, people who weren’t around while the person was using alcohol excessively. So many things can be triggers for relapse, and chief among those is often old friends, especially ones where drinking together was the primary bond between the two. In addition, new people won’t judge a recovering alcoholic by past actions, will provide other activities besides drinking, etc. They don’t even serve as reminders for previous episodes of drinking. Obviously, AA meetings are one of those places individuals in recovery will often go to meet people who are not only not drinking, but actually working on sobriety, but anyone can do, if they are leading relatively healthy lives. In addition, it’s important to try and set up people other than family members as individuals who will work on relapse prevention, especially if the family members have been involved before. Otherwise, bad dynamics all around, especially if there is a relapse.

3) Substitute Dependency - This basically means becoming very involved in something else. Hopefully, some form of moderation and balance can eventually be achieved, but in the meantime, an alcoholic without alcohol is likely to want to focus on something, anything, else. Work on finding that something, and do everything possible to ensure it is a healthy something. Alcoholism isn’t just about drinking, it is a complete lifestyle. Even when an alcoholic isn’t actually in the process of drinking, they are often either thinking about drinking, obtaining, alcohol, recovering from drinking, etc. That is, all of a sudden, a significant chunk of time freed up in one’s life. Better fill it with something else, or a person will simply go back to filling it with what they filled it with before.

4) Immediate, Negative, Definite Consequences to Drinking - this will often go hand in hand with hitting “rock bottom,” but not always. Basically, though, it often takes some sort of jolt of reality to awaken an alcoholic to the reality of their situation. It may be a health problem, an accident, a jail term, etc., but having this experience is correlated with a higher overall success rate. Now, no one wishes this sort of thing to happen, and treatment doesn’t involve purposefully impacting an individual with a negative consequence just to say “There! Treatment will be more effective!” However, unless something like this does provide a kick in the pants, be realistic about an alcoholic’s true level of commitment to recovery. Not saying it isn’t possible, just less likely.

Now, there are a host of other factors involved in treatment and recovery, these are just four of the big ones. Without these, the recovery process will be that much more difficult, if it’s even possible. The important, positive thing is, all of this stuff is possible, it’s been done before, by other people who were once in the throes of addiction. It can be done - just don’t say anyone ever said it would be easy.

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