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COMMON THEMES IN ALCOHOLISM TREATMENT: RELAPSE
Author: admin
COMMON THEMES IN ALCOHOLISM TREATMENT: RELAPSEAny individual with a chronic disease is subject to relapses. For the alcoholic, relapse means the resumption of drinking. Why? The reasons are numerous. For the relatively newly sober person it probably boils down to a gross underestimation of the seriousness and severity of the disease. Thus, the alcoholic fails to really come to grips with his own impotence to deal with it single-handedly. Hence, while perhaps going through the motions of treatment, there may be a lingering notion that although other alcoholics may need to do this or that, somehow it is not applicable to them. This may show up in very simple ways, such as the failure to change the little things that are likely to make drinking easier than not drinking. “Hell, I’ve always ridden home in the bar car; after 20 years that’s where my friends are”; “What would people say if________”; “There’s a lot going on in my life; getting to the couples group simply isn’t possible on a regular basis.” If families and close friends are not well informed about alcoholism treatment and are not willing to make adjustments, too, they can unwittingly support and even invite this dangerous behavior.For the recovering alcoholic with more substantial sobriety, relapse is commonly tied to two things. Relapse may be triggered by the recovery rut already described. On the other hand, if things have been going really well with the recovering alcoholic’s life proceeding quite swimmingly, there is the trap of thinking the alcoholism is a closed chapter.As an aside, probably as a response to this danger, one sometimes hears alcohol counselors, AA members, or those well acquainted with alcoholism stating a preference for the phrase recovering alcoholic, rather than recovered. It serves as a reminder that one is not cured of alcoholism. From a medical standpoint, this is quite accurate. The evidence points strongly to biological-biochemical changes that occur during the course of heavy drinking. Even with long-term abstinence, in this respect there is no return to the “normal” or prealcoholic state. The body’s biological memory of alcoholism remains intact, even if the recovered alcoholic has “forgotten.” The addiction can be rapidly reinstated. The alcoholic who resumes drinking may very quickly, in days or a week, be drinking quantities equal to amounts prior to abstinence.It is recommended that management of a relapse, should one occur, be discussed and incorporated into the continuing treatment plan. After all, relapse is not an unheard of occurrence. It is far better to discuss ahead of time how it shall be handled in an open discussion between client, family, and counselor. In the midst of the crisis of relapse neither the family nor client can do their most creative and clear-headed problem solving. Also, having gotten this taboo subject out in the open, it may be easier for all to attend to the work at hand, rather than worry about “what if.” Any plan for responding to a relapse should be very concrete; for example, the family will contact the counselor, the client will agree to A, B, C.Although one can look ahead in the abstract, it is during ongoing counseling that the counselor needs to be alert to possible signals of impending relapse. This can then be dealt with in individual sessions. Of course, part of the real meat of educational efforts is teaching the recovering alcoholic to become aware of danger signals. If a drinking episode occurs it does not have to be the end of the world; but neither should it be taken lightly. Whether it is one drink, or an evening of drinking, or a weekend, or a month, the alcoholic needs to be immediately reinvolved with a treatment center, a counselor, or— if active or previously active in AA—an AA member, or do several of these things. The important thing is not to sit back and do nothing. It is critical that a drinking cycle not be allowed to develop. Active intervention is needed to prevent this. If the alcoholic is still involved with you in treatment at the time of relapse, it is a clear sign that more help is needed. If the alcoholic is currently trying to become sober on an outpatient basis, while continuing to hold down a job and handle all the usual obligations, the drinking episode clearly shows that the approach is not working. A residential inpatient experience that allows and indeed forces the alcoholic to put full attention to alcoholism treatment may well be what is needed.The alcoholic may instead have “played” at treatment, seen a therapist a few times, and decided things were under control. Fully resolved not to drink again, he then terminated counseling. However, willpower and determination, even with a dash of counseling, did not accomplish what the alcoholic had intended; so the answer is a commitment by the alcoholic to engage in more substantive treatment.Seasoned alcohol counselors often say that the most dangerous thing for a recovering alcoholic is a “successful drunk.” By this they refer to the recovering alcoholic who has a drink, does not mention it to anyone, and suffers no apparent ill effects. It wasn’t such a big deal. A couple of evenings later it isn’t a big deal either—and so forth. Almost inevitably, if this continues the alcoholic is drinking regularly, drinking more, and on the threshold of being reunited with all the problems and consequences of active alcoholism. The danger, of course, is that the longer the drinking continues, the less able the alcoholic is either to recognize the need for help or to reach out for it. The alcoholic who has had a difficult withdrawal in the past may also be terrified of the prospect of stopping again. It may be wise for you to make it clear that if the client has a drink—or a near encounter—that you both agree it will be discussed.For the recovering alcoholic who has possibly attained substantial sobriety, reentry into treatment after relapse may be especially difficult. Among a host of other feelings there are embarrassment, remorse, guilt, a sense of letting others down. Recognition that alcoholism is a chronic disease, that it can involve relapses, may ease this. However, refrain from giving the impression that relapses are inevitable. Following a relapse, it is necessary to look closely at what led up to it, what facilitated its occurrence. The alcoholic can gain some valuable information about what is critical to maintaining his or her own sobriety. That is another reason it is so important to deal with a relapse openly. The counselor must also be sensitive to the issues that a relapse may evoke in the family.For the moment—and we emphasize the moment—the family also may be thrown back into functioning just as it did during the old days of active drinking. The old emotions of hurt, anger, self-righteous indignation, to hell with it all, may spring up as strongly as before. This is true even if— especially if—the family scene has vastly changed and improved. All of that progress suddenly evaporates. There also may be the old embarrassment, guilt, and wish to pretend it isn’t so.It is important that you as a counselor maintain contact with your clients for an extended period of time to help reduce the likelihood of relapse. Though your contact may be less frequent, and possibly appointment times less than a full hour, don’t allow the follow-up visits to become an empty ritual. Greeting clients with a “Hi, how are you?” and “You’re looking great,” and then escorting them to the door is not a very therapeutic style. If things are not going well, the client hasn’t been given much opportunity to tell you! Be alert to the fact that clients may be reluctant to talk about difficult times. They may feel they should be able to handle it alone, or they may feel they are letting you down. So, in conclusion, don’t be casual with follow-up care. It is as important as all the earlier sessions. By taking it seriously, you communicate this to your clients as well.The reason for the emphasis on considerable treatment over a fairly long period of time throughout this treatment section is simple. The people most successful in treating alcoholism are those who recognize that anywhere from 18 to 36 months are necessary for the alcoholic to be well launched in a healthy lifestyle. It might be said that recovery requires an alcoholic to become “weller than well.” To maintain sobriety and avoid developing alternate harmful dependencies, the alcoholic must learn a range of healthy alternative behaviors to deal with tensions arising from living problems. Nonaddicted members of society may quite safely alleviate such tensions with a drink or two. Because living, problems, and tensions go hand in hand, being truly helpful implies helping the alcoholic grow to a higher level of health than might be necessary for the general population.*108\331\2*
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STAGE THREE OF STRESS BREAKDOWN: DIFFICULTIES IN FINDINGS AND STUDIES
It is very difficult to find out what happens exactly in the brain at the cellular levelWhile scientists now understand a great deal about the brain, and while our knowledge of brain structure and function is expanding at an increasingly rapid rate, there are major problems in trying to work out how the individual cells and cell groups are affected by excessive stress.The brain is a complex, living organ, encased in a thick bony box, the skull; there is almost no way we can examine it closely without interfering with its function. Therefore, although we know a great deal about the structure of the brain, which we’ve learned from cutting it up and examining it under microscopes, we don’t know as much about the behaviour of cells in the normal functioning brain.
The difficulty of studying chemical changes in the normal functioning brainIf we wanted to study how certain types of brain stimulation might change the levels of neuro-transmitter chemicals in the brain, we are immediately hampered by the fact that the brain is full of enzymes, whose job it is to destroy the neurotransmitter chemicals as soon as they are produced and have done their job of firing off the next neuron.Therefore, in order to study changes in these neuro-transmitter chemicals occurring under conditions of high stress when the brain’s cells are over-stimulated, we would need to stop enzyme activity the moment that the over-stimulation occurred. In the laboratory, this would probably mean we would have to stimulate the brain, then immediately plunge it into liquid nitrogen to freeze it instantly, before cutting the brain into pieces and examining it.Of course, doing something like this is totally out of the question when we are trying to learn something about the way human brain cells respond to over-stimulation; therefore much of what we believe about brain function is often in the form of workable theories, which persist until a better theory comes along.
*26/129/5*
SLEEP WITHOUT DRUGS: FIRST VERSION
Author: admin
The following is version of the audio cassette Sleep Without Drugs. The rate of self-talk should be very slow, and the inner voice should be calm. There should be pauses between phrases, and when you talk to yourself try to feel every word you say to your body and let your mind physically travel along each part of your body. In the following, // means pause. This is the first version:
*104\174\4*
In many areas denial is quite a good way of psychologically protecting ourselves. If we are
confronted with some danger that we cannot avoid, it helps us to face the situation if we deny that it is dangerous. In order to convince ourselves we start by denying it to those about us. This makes it easier to deny it to ourselves, and we feel reassured.
Denial can be used in a similar way in an attempt to ease our pain. To the inquiry of our friends we answer, “No, it is not hurting at all.” This has two effects. In the first place it makes it easier to deny the pain to ourselves; and secondly there is a kind of primitive magic about it, the magic of saying something to make it come true. Children in their play evoke this kind of magic, and severe pain often has the effect of making us regress, so that we tend to behave in a rather childish way. Among adults we see an example of the same magic of words when someone refuses to say something bad about a friend in jest lest it come true.
Denial helps us to control our pain to some extent, but it is seldom complete. However, there is a quite important side issue. As long’ as we attempt to deny our pain, whether successfully or not, we at least hold off the destructive influences of distress, fear, and guilt.
*126\57\2*
Diaphragmatic hernia
“They say I have a diaphragmatic hernia. The specialist said I should have an operation to repair it. To prove his point he showed me some X-rays which, of course, was a complete mystery to me. What’s the use of showing someone X-rays when you know quite well they can’t understand them? The other specialist gave me some pills. Tranquillizers. Said, ‘Take these, and I don’t think you will have too much trouble from the hernia.’”
It seems that routine Z-rays show that many people have a diaphragmatic hernia, but have no trouble from it. The hernia is simply a slight protrusion through the muscle of the diaphragm.
Whether the individual gets trouble from it or not depends not only on the size of the hernia, but also on the individual’s nervous condition. That is, the sensitivity of his nerves to this particular disorder. In fact, it is not uncommon for people to say that the trouble comes and goes. In these cases it is unlikely that the hernia varies in severity. Much more likely, it is a matter of the patient’s perception of discomfort changing with his stress situation.
Premenstrual tension
“It’s really hell. It’s before my periods. Tense in myself. Irritable with others. Everything goes wrong. We don’t often quarrel. But if we do, that is the time for it. My fault, of course it’s my fault. Can see that, but can’t help it.
‘Have been on tranquillizers. Have taken hormone pills, not much help. Went to a psychologist. A clever young man. Just too clever. Told me I was frightened of getting pregnant. That’s why I was tense when my period was approaching. Explained I wanted another baby. ‘Ah,’ says he, ‘you are tense because you are not pregnant!’ I didn’t go back to him.”
As with so many disorders, a number of factors contribute to premenstrual tension. We all have our genetic inheritance. Some women have large breasts, some small. Some men a large penis, some small. The womb of some women is better developed than that of others. A poorly developed womb may be a cause of premenstrual tension because of difficulty in expelling the menstrual flow. The activity of the ovarian hormones, of course, is an important factor. With some women, psychological hopes and fears are important. So also is the matter of early conditioning. If the mother suffered from premenstrual tension, it is quite likely that she unconsciously conditioned her daughter by warning her to expect premenstrual discomfort and pain.
There is another point. Quite independent of our stress situation, some of us have more sensitive nervous systems than others. Those people have a lower threshold of pain, and consequently experience a stimulus as severe pain, which to others would be experienced simply as mild discomfort. Stress increases our sensitivity to pain, so it is important that such women should not further increase the sensitivity of their already unstable nervous system by stress.
There is often a tendency among doctors in talking to their patients with premenstrual tension to speak of the genetic factors as if they were a matter of doom. Something we are born with, and cannot be avoided. Our genetic inheritance predisposes certain women to premenstrual tension, but does not determine it in any absolute sense. For instance, our perception of pain can be effectively modified by the practice of meditation. Our level of stress can be reduced by the same means, and with it the over-alertness of our nerve cells with consequent reduction of their irritability.
*56/98/5*
Prostate
“What can I do to cope with it? The boss is driving me mad. As soon as I get there in the morning. On my back. The whole time. “Do this, do that.” What’s wrong here? Things that are not my fault. He can’t see it. If I were to argue with him, I would be out. He sacked the last two in my job. I don’t want that.
‘I’m not as young as I was. Have to get up at night. Sometimes three or four times. Then can’t get to sleep again. What can I do?”
The problem of his physical health compounds the problem at work. If his prostate troubles were relieved, he would be able to cope better with the rush of disturbing impulses from his work.
‘Flu
“Things have never been all that good between us. Worse the last two months. I remember this because that’s the time I got the ‘flu. Was pretty sick with it for a few days. Now things go wrong more easily. As he comes in I can tell if he has had a bad day. Used to be able to coast things along. But now I don’t seem to have the patience. It is as if I don’t care, but I do. It all goes wrong so quickly. I put my foot in it, and soon we are bickering.”
An attack of ‘flu, or, for that matter, any virus infection, often leaves us predisposed to stress. There are two factors, either of which may make things difficult for us. There is the general debilitating effect of the infection, which results in messages being sent to our brain that things are not quite right. And in some cases there is the direct effect of the virus on the nerve cells of our brain. This impairs their function, so that messages arriving at our brain are not as well integrated as they could be.
It is important for us to remember that the after-effects of a virus infection, not always, but sometimes, may linger on for some time afterwards.
*20/98/5*