Alcoholism Treatments: Success Rates (longish)

Factual Questions
1

I found a few threads on alcoholism, but nothing this specific, so here goes.

Got an alcoholic family member who might be ready to quit. I want some unbiased information on success rates for treatment methods – but I can’t find it!

I find claims by different clinics and such, but that’s not unbiased. NIH, NIAA, etc. discuss various treatment methods, but no clear recommendations – maybe they don’t want to be in the position of favoring one over another.

Does anyone know of good research out there, in print or on Web?

If any dopers are pros in the field, I’d appreciate their professional viewpoint as well.

Not looking for anecdotal evidence, which is why this is posted to GQ.

I guess I should say something about the personality type cause I know that affects what works – will try to be brief.

Longtime drinker, doesn’t deny or hide his alcoholism. No family history on either side. 6-7 beers/evening is “maintenance dose”. He can drink twice that in 4 hrs or so without seeming drunk. If he wants to get drunk (rare) he’ll start on tequila in addition to the beer.

About 10 years ago he quit for a good year and a half. Just decided to and did it. Then decided to start again and did so with no qualms. He quit smoking maybe 20 years ago cold turkey, after telling a friend he could do it.

Now he’s getting concerned about liver damage etc and doesn’t like how much he spends on alcohol.

12-step is off the table. We all agree that won’t work for him. He’s a virulent atheist, has no truck with “higher powers” of any sort, and honestly doesn’t care what anyone else thinks about what he does.

We lived for a while where pot was decriminalized, and he used that instead of booze for a while and was much easier to live with, but he quickly got to where he’d smoke it first thing and then all day (not so w/ booze) and he hated the side effects, so he went back to alcohol.

To be blunt, he’s a sociopath, and he does try to get along, but being around people wears him down (he calls it “being on stage”) – but he doesn’t want to retire, says there’ll be nothing to make him get up, and the extended family live together, so he’s around people every day. I think the drinking helps him let his guard down so he can let his anger out – which he does. But, thank God, never at the kids, and rarely even around them. Usually at stupid stuff like the TV or paper.

I love him anyway, what can I say, and I want to help him get his best shot at quitting.

2

This is an interesting question and I hope someone has an answer for you. This was falling off the first page so I thought I would give it a bump

Sorry, I have no info myself. Good luck!

3

AA seems to works best for those who had a religious upbringing, regardless of their current religious practices or how they lived most of their adult lives. I know several people who have done very well with them and several who have not. The deciding factor tends to be religion.

Sounds like this guy would do best with a therapeutic support group in conjunction with aversion medication. Hospitals often have programs for out-patient treatment of alcoholism.

Treatments are only as good as the person’s desire to stop drinking. It’s not something that can be brute-forced even with aversion medication. They just stop taking it. IMHO, therapy is a must. It is a hard and lonely time dealing with cravings and learning to recognize and avoid your “triggers.”

My brother is a life-long alcoholic who suffered numerous alcoholism-related illnesses, wild DTs, and even a near fatal alcoholism-related “brain bleed” a few years ago which left him with some cognitive damage. Even after that, he began drinking again. Luckily, he managed to get into a very good program with a place called the International Center for the Disabled. Through neuro-psychiatry and group psycho-therapy, along with aversion medication and anti-depressives, it seems he has finally licked the problem. Oh, now and then he may lose his balance and have a wine cooler, but he hasn’t fallen off the wagon in over 2 years.

More than really wanting to quit, he did not want to be kicked out of the program. It’s imperative to find a program that your family member can find useful and really enjoy. There has to be benefits to keeping clean and penalties for not. Of course, most alcoholics do slip now and then, and there is no crime in that, but these types of organizations expect you to seek immediate intervention; not wait until you’re finished with your “binge.”

4

It’s been about 10 years since I worked in the addictions field, and even then the focus of the clinic wasn’t alcohol, but I’ll do what I can.

AA does have one of the higher recovery rates - but as a rule of thumb, for ANY addiction a 30% success rate (meaning long-term abstinence) is about as good as it gets.

OK, this is actually a positive sign - sort of. He CAN do it. Now, the next question is does he want to quit? Because if he, himself, doesn’t want to quit no treatment program in the world is going to work. Sure, you could lock him up in a padded cell for a month, clean the alcohol out of his system, but all you have the end is a sober drunk. As soon as he’s out again he’ll head straight for the liquor store and tank up again.

If you can’t convince him it’s in his best interests to quit he’s not going to. I realize this may be a depressing answer, and not the one you’re looking for, but it is the truth. The first step towards recovery is his own, internal desire to be sober.

Well, OK, there’s some incentive for him.

Look into “Rational Recovery” - it’s a group with some similarity to AA (group support, peer support) but without the reliance on a “higher power”

The best strategy might be to try more than one program. It’s not uncommon for an addict of any sort to have to quit multiple times and go through several programs before recovery finally sticks.

Even if he’s only cleaned up for a year or two at a time, that’s better than being continually awash in alcohol.
Cillasi mentioned aversion medication and anti-depressives, both of which can help some people (and not help others). AA and RR both tend to be very down on the concept of using any form of medication to alleviate addiction (it tends to be viewed as substituting one crutch for another) but there are settings where group therapy and peer support is provided along with appropriate medication.

My personal feeling is that whatever method works is OK - and different folks require different approaches. You may have to try a few to see what actually works for your relative.

5

Broomstick already mentioned Rational Recovery, but providing you are not averse to it, try Al-anon. It can help even if he doesn’t stop drinking.

It is a support group for people who are affected by other’s alcoholism.

Regards,
Shodan

6

AA has large numbers of proponents because in terms of raw numbers there are many former alcoholics that are AA members, but even AA’s own figures show that 95% of members do not last a year. Several studies have shown that alcoholics (and other substance abusers) in treatment programs do no better or worse than those left to their own devices.

If he has managed to “just stop” both drinking and smoking I would suggest looking at the work of Stanton Peele a psychologist who doesn’t believe in the medical model of addiction. His site is full of resources and will at least provide you some perspective other than 12 steps.

Years ago I worked at an in-patient facility for addicts and from my experience Peele seems to have a very pragmatic approach. I loaned a copy of his book “The Truth About Addiction and Recovery” to a friend whose husband felt much like your relative. He read the book and gained sufficient insight into his behaviour to take his own steps to control his drinking. Not that the book seeks to be a form of treatment.

7

There is nothing that will make him quit until he loses something more valuable to him than the booze and then he probably will not quit. I am an alcoholic and I know this to be true. I lost eveything I had when I was 24 years old, before that I watched my Father die an ugly, alcoholic death and before that I saw his mother, my grandmother, die an even uglier, alcoholic death. I have been sober now for 17 years and I notice every liquor store everywhere I go. For an alcoholic to be sober requires a lifestyle change that must encompass everything they are. There is no formula that works, just guidelines to help. One must become militant about temperence.

8

Just wanting to stop drinking is seldom enough to quit. As hlanelee said, one must make some fundamental personal changes in order to no longer be driven by the need to drink. Mutual support groups, with or without a higher power, are very helpful in achieving this, when the alcoholic is really, really ready to change. And it really helps if the individual can accept that the alcohol (or the drug) is more powerful than they are.

If he is truly a sociopath, his chances are less than average, though.

9

I quit both smoking and marijuana at once. I agree with everyone who has said that it requires a lifestyle change. Within a few months all my old friends (minus a small minority of true friends) had stopped calling me. I believe that you need to replace his drinking with another activity that he will want to participate in.

10

I am not going to even go into alcoholism as it would require more time than I’m willing to spend on this post, but I will answer your question.

If he is willing, have your doctor prescribe “antibuse” (sp?). This drug is taken daily and if you drink while taking the drug you experience an extremely negative reaction. Extremely negative - see I said it twice. Have your doctor explain or read the literature or both.

This treatment program works best when an alcoholic has a functioning relationship with someone who is there to make sure the alcoholic takes the drug every morning. That is the key as the alcoholic will frequently or occasionally try to get off the drug and drink - because the alcoholic won’t drink while on the drug, at least not more than once, and that one time, well he won’t drink much.

11

If he goes to a facility good luck in finding anything other than AA. AA cultists now have a monopoly in drug addiction areas with the government even forcing meeting on people (hello, seperation of church and state) The facts are AA has no better or even worse success than just recieving basic addiction information and trying on your own. I have read the Rational Recovery book and as a fellow hardcore atheist found it inspiring. The truth is that if you are a hard core drunk it is almost impossible to stop unless you are VERY motivated.

12

Well, I’m glad you could spare a minute out of your busy schedule.

Thanks for answering my question about research on success rates.

For future reference, it’s Antabuse (disulfiram).

13

This is misleading at best. No one is forced to go to AA meetings. Those convicted of something like DUI are told to go to meetings as a condition of probation. If the person strongly rejects AA meetings then he can refuse probation and take the sentence.
One characteristic of we alcoholics is that we bitch and whine a lot.

AA is not a religion. I have very little use for organized religion or the concept of God that any of them I know about espouse. Nor is the concept of a “higher power” necessarily the God of organized religion. I’ve been sober for almost 23 years without a “higher power” because of the help and support of a lot of people like me.

14

OK, after that smartass reply – sorry, but it took a lot to post this question, and that post just rubbed me entirely the wrong way – I just want to say thanks to everyone who responded. I was worried for a while that I’d get nothing.

I’m still a bit frustrated at varying reports about recovery rates, but there’s been good information posted here. I’m really taking it to heart that we may have to “mix and match”.

I hope I’m not getting my expectations up too high, but he’s talking about quitting, and he’s pretty obsessive about doing what he says and saying what he does. Pray for us, if you’re so inclined.

I’m encouraged by Rational Recovery and Peele’s work – I think it will fit with his personality. If he decides to do this, and accepts my help (which he may not) I’ll report on another SDMB forum.

Especially helpful is the idea that there will have to be something that takes the place of drinking in his life. I don’t know if I used the term “sociopath” technically correctly, but I think I did. Somewhere down deep, I think it really hurts him that he can’t even love his family, or feel his love for them, and doesn’t know how to get along with other people except to put up a front, and can’t enjoy even playing with his grandkids.

If anyone knows of information on occupational therapy or the use of hobbies in alcoholism recovery, I’d surely welcome it right now.

Wish me luck. Wish us all luck.

15

No problem, I had a few minutes. And, a regimen of Antabuse will provide a 99.999 percent recovery rate if the regimen is followed religiously.

16

Antabuse is not a cure for alcoholism. Now this is purely anecdotal, so you may feel like discounting it. I have seen people die, drinking while taking antabuse and I know that antabuse also works only as long as the alcoholic takes antabuse. Take the drug away and it will not be long before they are drinking again. There are no magic pills. Unless the alcoholic changes most of what they believe in, they will continue to drink. I know a gentleman now that was denied a liver transplant because alcohol showed up in a urinalysis. He may still be alive.

17

I would doubt that hard numbers about recovery from alcoholism even exist. It’s a very fluid thing. At what point do you consider the alcoholic “recovered”? After one day sober? A year? 10 years? You have alcoholics who get sober for a number of days, weeks, or months, then start drinking again. Sometimes you hear stories of alcoholics who are sober for many years, and start drinking again. This is why statistics are so hard to find.

Sample_the_Dog, I’m sorry you’re going through all this, and I think it’s wonderful that you’re trying to help. But, as many have said, it won’t work at all unless the alcoholic really wants it to, and is willing to make the necessary lifestyle changes!

Best of luck!

18

[QUOTE=hlanelee]
Antabuse is not a cure for alcoholism. QUOTE]
I certainly agree. But, based on what was stated I believed the OP’s definition of recovery was simply not drinking (And a lot of others use that definition as well).

19

I’m actually encouraged by what y’all are saying, btw.

Found out through another family member more details about his quitting cigs. He was telling a friend how he (friend) ought to stop doing thus-and-so. Friend replies something like “I can’t ‘just stop’ any more than you can ‘just stop’ smoking” – which he’d been doing since a boy. The hell I can’t, he says, and makes a deal, you stop I stop, and I’ll stop forever even if you don’t. That was his last cigarette.

It was similar when he stopped drinking for a while. It was like, to hell with it I’m spending too much on scotch (it’s beer now). But he never said “never again”, and like I said, 18 months later he says “Gonna go have a drink with the guys from work” and he did. No agonizing, no guilt, no nothing.

He’s a control freak, and insists he can do anything he sets his mind to. So he doesn’t just speculate idly about doing anything serious. So just talking about quitting for good has us all stunned. If he says, “that’s it for good”, it would be a very hard blow to his pride, I think, if he went back on it.

I think he might be “really ready”.

20

Most hard-core alcoholics manage to drink on antabuse too. I’ve treated enough of them who are sick as a dog from drinking on it. And I treated one guy at least 6 times for drinking on antabuse. My current treatment approach for someone who has consumed alcohol while on antabuse is to tell them to go home and suffer their consequences.

Antabuse is a useful adjunct to other therapies, but by itself, it is not real helpful.

QtM, MD