July 15, 2010
Dear Jeff and Debra:
Our 38-year-old son has been an alcoholic since his late teens. He's been to outpatient counseling and inpatient treatment several times, but nothing seems to work. He says he doesn't like AA and doesn't identify with all the people there. His alcoholism has taken a terrible toll on his relationships, not to mention the havoc it's wreaked in our family. We've run out of answers and frankly we've run out of money to treat this problem. What works?
It's important to think about alcoholism as a medical problem that requires professional treatment. The American Medical Association recognized alcoholism as a chronic illness in 1955 (and Scientific American described certain kinds of drunkenness as a medical disease as early as 1877).
The biggest problem the medical community faces in dealing with chronic illnesses isn't a lack of effective treatments; it's the patients. There are no shortages of treatments for heart disease, diabetes or alcoholism; the problem is most patients don't follow the directions.
Their doctor will prescribe a specific course of treatment and the patient will initially comply, but once he starts feeling better, the patient ignores the doctor's advice and starts backsliding. Before long, he's right back where he started (or worse).
Chronic illnesses like diabetes and alcoholism cannot be cured, but they can be managed or put in remission. In the case of alcoholism, the goal is abstinence and an active program of recovery. But that's not as easy as it sounds.
We often hear resistant alcoholics making the same excuses as your son. The treatment didn't work for me — or — my counselor didn't understand me — or — I don't like AA. Let us be perfectly clear; these excuses are nonsense.
Let's start with treatment. Going to a high quality treatment center is like going to a high quality fitness center. Is it fair to say the fitness center didn't work? Was there really something wrong with the exercise equipment? No. Either the person uses the tools that are offered, as much and as often as required, or they don't.
The treadmill doesn't care if you like it or hate it, the treadmill just works. It may be difficult or tedious, but it works if you work it.
Likewise, treatment for alcoholism works for almost everyone who really follows the directions. The key is to follow the program. To make an analogy to another chronic problem, you can't expect to lose weight if you only diet Monday through Thursday. An effective diet is really a lifestyle change.
Patients don't have to like treatment or be ready for treatment. Just ask anyone who's been in a devastating accident that required months of physical therapy. Were they ready for the physical therapy? Did they like it? No. Such therapy is often painful and tedious. But it works if you work it.
What about the counselor? Their role is not to be a friend, but a coach and treatment manager. We have had effective treatments for alcoholism and co-occurring disorders like depression and anxiety for many years. But will the patient take the medicine, so to speak? It works if you work it.
When a newly recovering alcoholic says they don't like the people in AA, we have to smile. Alcoholics Anonymous isn't a social club. People attend AA to find solutions to difficult problems. It's a place where hard-won experience and knowledge is freely shared with the newcomer.
All walks of life are represented and the good cheer is contagious.
To return to your son, it's likely he hasn't followed his doctor's or counselor's directions thoroughly. He'll probably admit he left out a few small things. How important is that pinch of baking powder in a cake recipe? It works if you work it.
It's also likely he hasn't felt all the consequences of his actions. As family members, we're often too quick to soften the blows dealt out by this illness. We help pay the bills, mollify the employer and reassure other family members. Has he really felt the sting of his relapses or have the blows been cushioned? Unfortunately, it sometimes takes consequences to bring about compliance. Ideas we respect, but pain we obey.
If your son needs detox and treatment again, he should get it, but this time there should be some specific expectations when he's discharged. Work with the treatment team to develop a comprehensive aftercare plan, including a relapse agreement.
You can play an important role in the process by becoming more educated on the issues and not accepting his excuses. If other psychological issues require treatment, that's well within the capability of most modern treatment centers.
Like a good coach, you must stand for perseverance and let your actions serve as an example. It works if you work it.
Jeff Jay and Debra Jay are the authors of "Love First." Contact them through their website, lovefirst.net/.
Jeff Jay and Debra Jay are the authors of "Love First: A New Approach to Intervention for Alcoholism and Drug Addiction," and Debra Jay is the author of "No More Letting Go: The Spirituality of Taking Action Against Alcoholism and Drug Addiction." Jeff and Debra Jay are professional interventionists who live in Grosse Pointe Farms. They may be contacted with your questions at (313) 882-6921 or at lovefirst.net.