Alcoholism relapse problems

Treatment is best approached by using a disease model in which alcoholism is considered a chronic medical disorder and not simply a psychological or social problem. As with any other chronic illness, relapse is a normal part of the recovery process. Because the etiology of alcoholism is unknown and it afflicts a heterogeneous population, therapeutic strategies must keep in mind that some will not respond to more accepted forms of management. In this context, agents that reduce one s desire to drink may be important adjuncts (406). 

Allsop, S., Saunders, W., and McNamee, B. (1987) Relapse Prevention Management with Problem Drinkers The Results of a Controlled Trial, Paper presented at the 7th International Conference on Alcohol Problems, Liverpool. 

After detoxification, psychosocial therapy either in intensive inpatient or in outpatient rehabilitation programs serves as the primary treatment for alcohol dependence. Other psychiatric problems, most commonly depressive or anxiety disorders, often coexist with alcoholism and, if untreated, can contribute to the tendency of detoxified alcoholics to relapse. Treatment for these associated disorders with counseling and drugs can help decrease the rate of relapse for alcoholic patients. 

Relapse is such a long-standing problem in alcohol and drug treatment that there is little we can do about it. 

Any discussion of alcohol and drug treatment is incomplete without including relapse. Defining and measuring relapse are not as simple as you might think, but in concept it means the reappearance of some problem after a period of its remission. With physical diseases such as cancer, which is where the term relapse comes from, its measurement is more straightforward. 

You have seen that arriving at a definition of alcohol and drug problems that has general consensus is no easy matter, however. This difficulty carries through to defining relapse, as reflected by the different operational definitions that have been used in research on this topic. 

Naltrexone (revia see Chapter 22) has been shown to block some of the reinforcing properties of alcohol and has resulted in a decreased rate of relapse in the majority of published double-blind clinical trials. It works best in combination with behavioral treatment programs that encourage adherence to medication and to remaining abstinent from alcohol. A depot preparation with a duration of 30 days (vivitrol) recently received FDA approval and may improve medication adherence, the major problem with the use of medications in alcoholism. 

The other problems mentioned in this section (the fact that so many people with alcohol and other drug problems do not acknowledge the need for help, the problem of retaining chents in treatment, and the frequency of relapse among chents fohowing treatment) are related to each other. In order to understand this relationship, it is necessary to examine some controversial issues in treatment. 

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