By exposing the drinker to cues for drinking that might normally
stimulate intense craving, and by refusing to reinforce those cues with
the "pleasure" of drink, alcoholics become less responsive to those cues
over time. The drinkers' sense of self-confidence and efficacy rise,
proving that they can restrain from drinking in the presence of cues. And
it provides the opportunity for drinkers to learn how to cope with their
problem in the outside world.
Typical drinking cues, notes Liljegren, include money, payday,
peers, parties, bars and other drinking settings, and
emotions -- particularly anger, sadness, and fear. "I had a young woman
here," recalls Liljegren, "who was very upset about her ex-boyfriend, who
himself was a drinker. I asked her mother to bring in a picture of him.
When she saw the picture she was very upset." Liljegren and the patient
were able to explore the patient's feelings until she was confident that
she would not drink when she actually bumped into the young man out in
the world.
One of the biggest shifts in alcohol treatment is from inpatient to
outpatient therapy. "Research has found that less costly outpatient
programs may be as effective as inpatient programs," points out Donovan.
Outpatient treatment allows patients whose prognosis is more favorable to
adjust to life without booze in a real-world environment. And it's a lot
cheaper.
In contrast, alcoholics with preexisting medical or psychiatric
illnesses -- and whose insurance company or bank account can cover
bills -- should consider in-patient treatment. So should those who have
failed outpatient therapy, or whose family environment is chaotic.
It's during the months and years that follow initial treatment,
says Schuckit, that the real work of recovery takes place. "Counselors
work with the patient and family. Giving up alcoholism is a loss of a way
of life -- and the alcoholic needs to grieve. Magical thinking needs to be
corrected; many patients and families have the idea that all problems
will fade as they become sober. Families need a way to deal with the
spouse anger that inevitably comes out as the patient becomes sober, and
to maintain enthusiasm.
"Contact with recovering people is important, as is access to
self-help. The former drinker needs to set up plans about what to do with
free time that used to be spent drinking. A whole life needs to be
rebuilt without alcohol. Relapse prevention is important. A former
alcoholic needs to identify the triggers to drink and rehearse strategies
to help him handle those triggers. Perpetual alertness is
required."
Ironically, the months following intensive treatment can put more
strain on a family than years of chronic alcohol abuse. About 25 percent
of marriages break up within a year of one partner's joining AA, says
Barbara McCrady, Ph.D., clinical director of the Rutgers Center for
Alcohol Studies. She cites three reasons:
o Traditional AA protocol calls for meetings -- lots of them.
"Spouses often say, 'First I lost him to alcohol, now I've lost him to
AA,'" says McCrady. The alcoholic's reliance on fellow program members,
rather than family, can foster considerable resentment.
o Some families have for years blamed all of their difficulties on
the alcoholic's addiction. Only when the drinker is no longer drinking do
they realize that long-established alcohol problems do not just vanish
overnight.
o Families that remain intact despite a member's drinking have
worked out their own ways to remain a family unit. "They've reallocated
responsibilities, roles, and chores, and the family functions pretty
well," McCrady says. "Now there's this person who is sober and wants to
reestablish a position in the family." But the family may be hesitant if
the alcoholic has tried -- and failed -- to stay sober in the past.
Perhaps one of the most interesting new paths of research is the
study of alcoholics who quit on their own. "We are beginning to explore
in depth the characteristics of these people -- the ones who can just walk
away from their addiction in the absence of any formal treatment,"
explains Donovan. Perhaps they simply have in greater measure the same
hope and courage of the ordinary alcoholic, who frequently quits for a
day or a week or a month, and then returns to the hottle. As researchers
are beginning to realize, if they can emphasize the innate capacity
present in most drinkers to improve, a great deal may be gained. A shift
in viewpoint can help lift the burden of an all-or-nothing view where
"one drink, one drunk" means that a glass of champagne on one's wedding
day is an unequivocal failure.
TIPS FOR QUITTERS
Alcoholics can quit or control their drinking -- in fact they do it
all the time. The real issue is, how to sustain recovery? Relapse is the
bugaboo of alcoholism treatment. Whether the goal is total abstinence or
controlled, moderate alcohol consumption, there are effective ways to
minimize the dangers of a relapse.
o Avoiding situations like parties or bars, where you might feel
pressured to drink, minimizes the need for self-discipline. "If you need
to be strong, you haven't been smart," says one expert.
o Rehearse in advance what you will do or say when you are
confronted with a high-risk situation. You'll be better equipped to
resist.
o Keep in mind that for most alcoholics, the urge to drink lessens
over time. The first 90 days are the hardest.
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