W
e hear a lot about how many patients relapse following treatment. The implication is that treatment is a waste of time and resources. I work in a treatment center and have seen plenty of successes, especially if you accept the reality of a relapse or two on the way. What gives?”
I think it depends on how success is defined. If you define it as continuous sobriety from the day of admission going forward, then the numbers will be unimpressive. If you define success the way most behavioral health experts do, in terms of improvement in living, things seem a lot brighter.
You’ve heard us use Vaillant’s analogy of diabetes and hypertension — two other chronic disorders heavily influenced by lifestyle and therefore requiring extensive cooperation on the part of the patient to achieve stable recovery. Like alcoholics, many diabetics and hypertensives struggle with medication regimens, diets, exercise programs. There’s a learning curve involved; some patients recover much faster than others. Most (not all) eventually reach a point of relatively good control, and as a result avoid some of the worst consequences of their disease.
That’s pretty much what happens with alcoholics, at least the minority that gets professional treatment. Most don’t, of course, but that’ s another discussion. Take this review of the outcome literature by William Miller, a psychologist famous for developing modern motivation enhancement strategies. He and his co-investigators found that in the first year after an episode of treatment (any treatment), some 25% of patients stayed continuously abstinent. Another 65% drank during the year but reduced their overall consumption of alcohol by some 87%. This was especially important because it led to a 60% reduction in the problems that alcohol caused in their lives. They had yet to achieve stable abstinence, but were in fact in much better shape than before treatment.
This parallels the experience of many diabetics and hypertensives. Some patients respond to treatment quickly and do very well. The majority of others have an extended period of adjustment but overall experience significant gains. There’s a percentage who remain noncompliant but somehow don’t seem to suffer. That brings up the question of whether the initial diagnosis was correct.
Likewise, some ten percent of the subjects in the Miller review seemed able to control their drinking, which led to questions about their diagnosis, too. I don’t have an answer.
Perhaps most important to a family member, the death rate among treated alcoholics was below 2%.
From a healthcare perspective, it’s actually quite a positive picture. Our longstanding practice of branding anyone who drank again a ‘failure’ kept us from recognizing very real success right under our noses. Because of this and other research, clinicians began to focus on relapse prevention. And on the challenge of retaining the alcoholic in treatment, in the event of a temporary return to drinking.
