The administrator of a large
hospital recently gave me a tour. As
he showed me the cancer, cardiac, and renal dialysis units, he
emphatically told me that the hospital was committed to these
chronically ill patients. He stated with pride that no matter how sick, how difficult
their recovery, or how many treatments they needed the hospital was
committed to be there to help.
When we went to the chemical dependency unit, he
told me in no uncertain terms that the unit did not "enable
chemical addicts by readmitting them for treatment after relapse." His position was that if chemical addicts wanted to stay
sober they would. Relapse, he emphasized, is a "self-inflicted
condition" and to provide multiple treatments is enabling their
Unfortunately, this misguided attitude is still
very common. We say that
chemical dependence is a disease with a tendency to toward relapse, but
many treatment centers don't act like it is.
Even more tragically, these misguided policies of refusing
multiple treatments to relapse-prone addicts are being mirrored in
insurance company and managed care reimbursement policies which are now
refusing to pay for multiple treatments. There is even talk of refusing
alcoholics the opportunity for liver transplants because their liver
disease was self-inflicted.
Currently, most relapse prone patients are unable
to access treatment because of three mistaken beliefs:
Relapse is self-inflicted;
Relapse is an indication of treatment failure; and
Once relapse occurs the patient will never recover.
Let's challenge this triad of mistaken beliefs.
Mistaken Belief #1:
Relapse Is Self-Inflicted
Relapse, in most cases relapse, is not
self-inflicted. Relapse-prone patients experience a gradual progression
of symptoms that create so much pain that they become unable to function
in sobriety. They turn to
addictive use to self-medicate the pain.
These patients can learn to stay sober by recognizing these
symptoms as relapse warning signs, identifying the self-defeating
thoughts, feelings, and actions they use to cope with them, and learning
more effective coping responses. Unfortunately,
most relapse-prone patients never receive relapse prevention therapy,
either because treatment centers don't provide it or their insurance or
managed care provider won't fund it.
Mistaken Belief #2:
Relapse Is An Indication Of Treatment Failure
Relapse is not necessarily a sign of treatment
failure. Between one half and two-thirds of all patients treated will
relapse, but at least one half of all relapsers will find long term
recovery. The belief that
relapse means that treatment failed ignores the fact that, for many
patients, recovery involves a series of relapse episodes.
Each relapse, if properly dealt with in treatment, can become the
a learning experience which makes the patient less likely to relapse in
Chemically dependent people can be divided into
three groups based upon their recovery and relapse history.
One third of all patients are recovery
prone and maintain total abstinence from their first serious
attempt. Another third are transitionally relapse prone and have a series of short-term and low
consequence relapse episodes prior to finding long-term abstinence.
The final third, the most difficult patients to treat, are chronically
relapse-prone patients can't find long-term sobriety no matter what
Recovery-prone patients tend to be addicted to a
single drug, have higher levels of social and economic stability, and
not have dual diagnosis or serious coexisting problems.
They are what are often referred to as "garden variety
addicts" who have uncomplicated chemical addictions.
Transitionally relapse-prone patients tend to have
more severe addictions that are complicated by other problems.
They have the capacity, however, to learn from each relapse
episode and take steps to alter or modify their recovery programs to
avoid future relapses.
Chronically relapse-prone patients tend to have
severe addictions complicated by serious dual diagnosis. Most chronic relapsers have either severe post acute
withdrawal caused by the effects of chronic alcohol and drug poisoning
to the brain, a coexisting personality or mental disorder, or a serious
coexisting physical illness. Many
fail to recover because these coexisting conditions are not properly
diagnosed and treated.
Mistaken Belief #1:
Once Relapse Occurs The Patient Will Never Recover
Even chronically relapse-prone patients are not
hopeless. In 1988 I had dinner with over sixty skid row alcoholics who
had completed a relapse prevention program at Alexandria Regional Detox
Center. These people were
previously labeled as hopeless and given short-term revolving door
non-medical detox. All were
sober for over six months after participating in weekly outpatient
relapse prevention groups coupled with twelve step programs.
All of these people wanted to stay sober.
Prior to relapse prevention therapy, they did not know how. Once they learned effective strategies for identifying and
managing relapse warning signs, they were able to stay sober in spite of
the other serious problems they experienced.