Guest Post by Lisa Frederiksen
Often as rehab winds to a close (whether that be a 28-day residential treatment program or an intensive out-patient program or AA on its own or …), family members and friends get very anxious. “Will she be able to stay sober this time?” “What if he relapses.” “I haven’t met his sponsor, and I need his sponsor to make sure he goes to meetings!” These are understandable concerns — especially given what we hear and read about famous people relapsing time and again or our own personal experiences of a loved one who’s gone through more than one rehab, already. But, there is new hope and a huge reason for optimism when we understand alcoholism for what it is — a chronic, often relapsing brain disease — and that treatment of alcoholism requires treating the brain, which takes time. Now to more fully explain.
Thanks to late 20th and 21st century brain and addiction-related research findings, it is now understood that alcoholism is a chronic, often relapsing brain disease (one of the brain diseases of addiction). What does that mean — brain disease?
By its simplest definition, a disease is something that changes cells in a negative way. All diseases – cancer, diabetes, heart disease, HIV-Aids, to name a few – affect some type of cell in our bodies. This is because every organ inside our bodies (heart, brain, liver, eye, kidney, lung, stomach) is made up of cells. Some diseases affect many organs. Some affect one or two. Alcoholism affects cells in many organs but of particular concern is its effect on cells in the brain. This is because the brain controls everything we think, feel, say and do, and its alcohol’s affect on the brain that changes the way a person thinks, feels and behaves.
How is it a brain disease? First of all — alcoholism is not alcohol abuse [watch 10-minute video linked below], however it gets its start with alcohol abuse. In fact, all alcohol abusers go through a period of alcohol abuse but not all alcohol abusers become alcoholics. Taking it from here, then… The chemical and structural changes in brain cells and neural networks brought about by alcohol abuse [repeated binge drinking, routine heavy social drinking], coupled with the brain cell and neural network changes brought about by the five key risk factors for developing the disease (genetics, social environment, childhood trauma, mental illness and early use), cause the disease of alcoholism to actually change brain functioning. With alcoholism (vs. alcohol abuse), the brain embeds addiction-related neural networks around the characteristics of the disease, which include: cravings, loss of control, physical dependence and tolerance. The nature of these characteristics and the neural networks embedded around them makes it impossible for an alcoholic to drink any amount without kick-starting their disease. [An explanation of how alcohol hijacks the brain is beyond the scope of this post, I’m afraid.]
The good news is the brain can heal from the disease of alcoholism. However, this same 21st century brain and addiction-related research now shows that treating alcoholism must follow the same treatment protocols as treating any other disease, such as cancer, diabetes or heart disease. Instead of the old acute care model (i.e., 28-day rehab), treating addiction must follow the disease management model, which is a three-pronged approach and involves: 1) detox/stabilization, 2) rehabilitation (rehab) – commonly referred to as “treatment,” and 3) continuing care.
Number 3, continuing care, is especially important because part of the disease of alcoholism (addiction) is that it is relapsing. The very nature of this disease causes chemical and structural changes in areas of the brain that are vital to a person’s ability to think straight, behave normally and act responsibility. Because alcoholism is a brain disease, it is highly unlikely that all aspects of healing the brain can be completed in 10, 28 or even 60 days during part 2, rehab. Yes, a great start can be made, but a continuing care (a.k.a. an after care) plan that extends “treatment” for at least a full year is critical. Just as a person with diabetes, heart disease or cancer has a continuing care program/plan to help them continue their recovery once the acute care treatment (e.g., surgery, radiation, chemo) is complete, so too must the alcoholic.
To be most effective, a continuing care plan should go far beyond the “typical” urine testing and 12-step meeting attendance monitoring. It should include specific strategies that outline how the alcoholic is going to maintain abstinence and a productive, enjoyable life after the detox/stabilization and rehabilitation phases have been completed. It helps to think of it as relapse prevention. And it especially helps if it includes plans for how to integrate with the family; for how to deal with the fall-out of not dealing with “life” while in their addiction (e.g., credit destruction, parenting issues, relationships problems, foreclosure, lost jobs, lost friendships — the “life” situations than can trigger a person who is in early recovery [day 29, 30, 45 or 72, for example] to relapse); and for what the family needs in order to help themselves and in that process, help their loved one.
Why so specific? so detailed?
Any number of cues – sound, sight, memory, the smell of alcohol, an emotion, a stressful person or situation will trigger the alcoholic’s embedded addiction-related neural networks. Therefore, planning how to prevent and/or handle such cues is critical. Let’s face it, treatment for a heart disease patient or diabetic doesn’t stop after the person is stabilized, nor is it assumed a patient’s diabetes or heart disease goes away after the rehabilitation effort. Instead, those patients are counseled, provided education and behavioral modification strategies, and then they are given a continuing care plan and follow-up with further modifications, if necessary. This same approach must be used with treating alcoholism. For as you can imagine by now, healing, developing and changing neural networks takes time.
For more information about the disease of alcoholism — of addiction in general — visit The Addiction Project
produced by HBO in collaboration with the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Drug Addiction (NIDA), and the Robert Wood Johnson Foundation
Lisa Frederiksen is a researcher, writer, speaker and consultant specializing in 21st century brain and addiction-related research as it relates to addiction, substance abuse, mental health, and secondhand drinking/drugging(SHDD). She is the author of If You Loved Me, You’d Stop! and Loved One In Treatment? Now What! and writes the blog, BreakingTheCycles.com.