Is Alcoholism More Difficult to Treat than other Diseases?”

Nancy B. Irwin, PsyD, Primary Therapist at Seasons Malibu

Teenagers playing video games drinking beer and eating popcorn

Alcohol can certainly be more challenging to treat than other substances for several reasons. One is that it there is a longer continuum that is affected by genetic and environmental factors; many young people start out drinking socially – – responsibly and moderately – – and the consumption increases so gradually over time it can be extremely hard to detect, until it is too late. Many times this disease has a much slower progression than other chronic disorders, which can be insidious. A second major factor is that alcohol is omnipresent in our culture. Not only is it visible in nearly every restaurant, home, concert arena, and stadium, but approximately one-third of TV and print commercials advertise alcohol. This mass hypnotic suggestion encourages a positive association with alcohol, particularly when the beverage is paired with an attractive female, a muscle car, or other markers of success.  There are no commercials for heroin, crack cocaine, or crystal meth.  Indeed, these are not glamorized in movies or advertisements.    

Alcoholism quite often is viewed as an acute disease vs. the chronic one that it is.  A recent paper from The American College of Physicians recommends treating addictions with a lifelong protocol vs. a short-term one.  While the relapse rate for other chronic diseases, such as cancer, diabetes, or heart disease are comparable to alcoholism, few people shame, judge or discriminate against those patients.  Alcoholics continue to suffer the social stigma of being “weak” or having a “character defect.”  In reality, nearly all chronic diseases have a confluence of genetics and environment. 

Since alcohol is legal and so socially accepted, relapse for an alcoholic is much easier to rationalize.  As with any addiction, relapse is part and parcel of the recovery process.  Many alcoholics, and those affected by them, view relapse as failure and “proof” of their weakness and character flaws. However, recovery is a dynamic process; failure is built into the path to ultimate success, just as it is in learning to master any new task.  Whether learning to walk, ride a bicycle or learn a musical instrument, “failure” allows us to learn. Indeed, relapses can be reframed as “stepping stones” or a “dress rehearsal” to success.  Learning from any relapse increases awareness, underscores where one is vulnerable, and trains an alcoholic to manage his/her lifestyle and choices more mindfully. 

Standard treatment has traditionally included detox, an inpatient rehabilitation program, outpatient treatment, self-help (12-step) support groups, private psychotherapy with an addiction’s specialist, behavioral modification training, medication (e.g. Naltrexone), and lifelong monitoring and management for maintenance of sobriety. As well, a healthy awareness, coping skills and respect for the potential relapse is crucial to halt the progression and stay in remission with this disease.  In addition to standard treatment for alcoholism, neurobiology of addiction education can inform alcoholics, as well as their loved ones, of the neuroplasticity of the brain. The brain is malleable and uploading new “software” for healthy thoughts and behaviors, essentially resetting the impulse control, memory, and reward centers in the brain.  

How does this help the alcoholic more than another substance abuser? Very simple: molding the brain with new neural connections for self-awareness to respond vs. react to meet the barrage of triggers than many alcoholics face day to day.  This can be done through mindfulness-based relapse prevention, or meditation.    

Adapting a positive, growth-oriented mindset as opposed to a negative, fixed one is crucial in managing self-doubt, increasing trust in one’s ability to stay sober and to manage any overwhelm in social settings, family interactions and public places. Adding just thirty minutes a day to one’s “mental hygiene” for mindful meditation can retrain the brain for success in sobriety. 

Dr. Irwin is a licensed clinical psychologist on staff at Seasons Recovery Center in Malibu (www.seasonsmalibu.com) and is also in private practice in West Los Angeles (www.drnancyirwin.com). A frequent media guest, she is the author of YOU-TURN: CHANGING DIRECTION IN MIDLIFE (2008) and co-authored BREAKING THROUGH: Stories of Hope & Recovery (2017).