The tragedy of celebrity suicide is not new to the Los Angeles scene, and the recent deaths of two rock stars, shed light on the fragility of our mental health, reminding us that no one is immune. It also highlighted the struggles of people suffering from chronic alcoholism and other addictions, as both celebrities had long term battles with substance abuse and both relapsed before their suicides. As experts in the field of recovery, we need to ask two questions. What hope do chronic or extreme alcoholics have, and how do we as professionals best treat them and help them obtain long term sobriety and mental well-being.
The answer to both questions is clearer and more promising than probably many assume. There are a large variety of treatment options available for chemical addiction and mental illness. Hope is alive, and help is available. As behavioral health clinicians, it is our job to be client-centered, identify one’s immediate needs, and assist our clients in getting the best care possible. Personal, individualized treatment is necessary for recovery and transforming mental suffering into mental wellness.
First Things First
Excessive use of alcohol is dangerous and has proven to be life threatening yet no one is talking about it. In fact, the National Institute on Alcohol Abuse and Alcoholism, a division of the National Institutes of Health, is conducting a new $100 million study to identify the possible health benefits that can come from moderate drinking. Not surprising, this study is primarily funded by the alcohol industry. As experts in the field of treatment, we do not need to spend $100 million dollars to show how destructive alcohol can be. Let’s just look at the facts.
Damage done by chronic alcoholism can and will destroy the mind and the body. Cirrhosis of the liver from chronic alcoholism was ranked as the 12th leading cause of death in the U.S. This number does not include the deaths caused by accidents, drunk driving, and homicide/ suicide in which alcohol was involved. There is still the perception that because alcohol is “legal”, it is not as dangerous as other drugs. It is glamorized in the media and far too socially acceptable.
A commonly unknown fact is that detoxing from alcohol can be life threatening. In fact, it is more dangerous than detoxing from heroin. Treatment needs to start with comprehensive medical evaluation for individuals with a long history of alcohol abuse including chronic relapse. Supervised medical detox is often necessary for people suffering from an alcohol use disorder. While it is more common and necessary with longterm use, it is never something to attempt on your own.
Treatment Compliance vs. Treatment Acceptance
For too long we have focused on whether or not a client is compliant with their treatment and doing “what they are told”. Clients are still being labeled as treatment compliant in many places. This term is often heard during insurance reviews for medical necessity and plays a role in whether or not treatment will be authorized. It needs to stop. Think about an individual who has diabetes being denied treatment because they deviated from a diabetic diet. That would be unheard of. Treatment compliance puts the client in the position of being a passive player in their treatment and gives them no stake in its success or failure.
Treatment acceptance should be the goal to work towards with any client, but especially with people with a severe addiction to alcohol. They need to be more involved in the process, be more motivated, and have a greater stake in the success of their treatment than anyone else. Working with them, creating goals for treatment together, and rolling with resistance will help increase the chances of successful long-term sobriety. To put it simply, clients need to buy into the fact they need help; they need to accept treatment and become an active member of their treatment team.
Client Centered Planning
In treatment settings, client centered planning is imperative. The concept is simple; the client should be empowered to be an active member of their treatment program, including setting goals and identifying how they will measure success. Ultimately, when a client is part of the solution, they are more apt to follow the plan. Professionals have the best chance of treatment success when everyone is working together, including the client.
The Stages of Change
Many people do not believe change is possible and it scares them. Having worked in the field of psychology for over 15-years, there is no doubt in my mind that change is in-fact possible. Change nonethe- less is hard, and it holds true for individuals struggling with chronic alcoholism. Years of alcohol abuse can rob oneself from making healthy choices; such as seeking treatment or asking for help. But change is possible. Someone presenting at a treatment facility or asking for help from their provider is courageous and is the first step in the recovery process.
DiClemente and Prochaska presented a model for change that takes a person throughout the process of changing and maintaining new behavior. The Stages of Change are cyclical, nonlinear and seen as an ongoing process. It is important to note that once a new pattern of behavior becomes well practiced and routine, odds of relapse go down. Staying aware and mindful of potential to relapse has kept many in recovery from relapsing.
The stages include pre-contemplation, contemplation, preparation, action, maintenance, and possibly relapse. One stage blends into another as people begin to make the efforts to change, leading one on to a new stable pattern of behavior, and back to the beginning stage, repeating the cycle if necessary.
The model starts with a person being in pre-contemplation mode. There is no awareness that there is a problem that necessitates change. The individual most likely has not suffered any significant consequences and is possibly even getting pleasure from the behavior. Most human behavior does not require change and often goes on for the course of a person’s life. However, some actions are unhelpful and unhealthy, and this moves the person toward the stage of change.
Contemplation is the next phase in the model. Here a person is aware that what they are doing is not helpful or healthy, and could be detrimental to their well-being. “This is an event, not a stage. The person concludes that the negatives of the behavior outweigh the positives and chooses to change their behavior.”
Preparation comes next. Exploring options, finding resources, and making plans are part of this stage. Here we see a person marshaling their resources so that they can take whatever steps necessary to change what they are doing. Preparation can be quite easy and quick, or hard and arduous, depending on options and resources available.
After laying all that groundwork, the action phase takes place. This phase is where the behavior change begins, and the harder work takes place. Here an individual will take steps to implement the plans created in the preparation stage, utilize the resources found and needed, and do something different. For some it will be entering a treatment facility, others it may be reaching out to a trusted advisor, or possibly attending a 12- step meeting.
The action consists of reviewing what changes are being made, and access if they are working or not. Part of this step is considering if the new things that have been added are working, and if not, try another action to discover what will.
Maintenance is the next phase in the change process. Here the individual has changed their behavior and surroundings to ensure their life is becoming stable and routine. New practices, new supports, and additional resources are available and readily used, and the person is fully engaged in recovery.
The potential last phase of change is relapse. It is listed as both a reminder to be vigilant in change and recovery, as well as to acknowledge the difficulty of learning new behaviors and ways of being. Not all will relapse, but the model allows for room for transgressions, without having to start all over again. Prevention includes being mindful of warning signs, triggers, and what each need for self-care.
Supports and Step Down
Support increases the odds of long term sobriety for chronic alcoholics. Ongoing support with a 12-step type program, or other models such as Smart Recovery, can help the client reach long-term sobriety. It provides better outcomes than having no support or aftercare, and increases the opportunities for social support and assistance for those struggling with their addiction. Having continuity of care during treatment and transitioning seamlessly from inpatient treatment to outpatient treatment, and aftercare is crucial in a comprehensive treatment plan.
It is difficult for individuals actively struggling with alcoholism to hold on to hope. There has been a lifetime of feeling hopeless for many. We have repeatedly heard how they woke up every day for 10 or more years wanting to stop drinking and every night they drank again. Our job as addiction treatment specialists is to provide the client with the hope that they can change and know recovery is possible. Keeping them motivated, helping build rapport with them, letting them guide us, will go a long way to reach the end goal of a healthy and sober individual.
Candice Feinberg is the Executive and Clinical Director at Avalon
Malibu. She is an industry leader in developing innovative, evidencebased
therapeutic programs for individuals suffering from mental
health and addiction issues. Dr. Feinberg, a highly-respected authority
in the field of mental health and addiction issues, has appeared on
national television, and written articles published in Psychology Today.