Ask an Expert: What If Your Wife's Detox or Rehab Isn't Working?
Today's question is on where to turn after your wife keeps relapsing badly after several alcohol detox programs. Send your questions to firstname.lastname@example.org with the subject "Ask an Expert."
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Are there differences in detox? My wife has been in and out of treatment for serious alcoholism for several years and then relapses very badly every two or three years. Her physical craving seems to become overwhelming. Over and above insurance I have spent a fortune on this. Also, I am sorry to say, I don't help the situation sometimes by showing my frustration. Recently I have been reading there are a number of forms of detox. I am looking for recommendations about the most effective, maybe something even out of the box, so we can compare it to past detox experiences she has had which have not stopped the physical craving in its tracks. Yes, she is in therapy as well.- Arthur.
Lance Dodes: Arthur, you stated your question as if it is about detox, not rehabilitation facilities, which makes a big difference. Detoxification from drugs on an inpatient basis is a medical procedure which is basically the same everywhere. It is not related to the relapses you describe, since once the detoxification is completed (usually no more than a matter of days), there is no more physical addiction. For that reason, your wife's relapses much later are not due to "physical craving." Relapse urges are driven by emotional factors for which drug use is an attempted solution. The appropriate treatment is to figure out the factors that repeatedly precipitate these urges (I describe this in detail in my book, Breaking Addiction).
If what you are asking about is not detoxification itself, but inpatient rehabilitation programs, then you should understand that the rehab industry is unregulated, so rehabs may offer any kind of unproven treatments and claim any wonderful results they want, without evidence. There is also no reason to think that paying more will get you better treatment. Indeed, the most expensive and well-known facilities charge for such irrelevant "treatments" as horse therapy, "ocean therapy" (a trip on a yacht), aerobic exercise, and more. If you are considering an inpatient rehabilitation stay,
I would look for a shorter (no more than 2 weeks) and less expensive facility that offers zero horses and does not insist that everyone buy into whatever is their standard program. Ask if most treatment is done in groups or whether there is truly individual therapy, and ask about the academic qualifications of the "therapists." Avoid places that are "12-step-based" unless your wife is in the 5-10% who do well with that approach. Finally, if your wife has had extensive periods of abstinence and not benefitted from longer hospitalization beyond physical detoxification, I would obtain a careful review of her situation before embarking on another inpatient stay.
Lance Dodes, MD, has been Director of the substance abuse treatment unit of Harvard’s McLean Hospital, Director of the alcoholism treatment unit at Spaulding Rehabilitation Hospital and Director of the Boston Center for Problem Gambling. His books, The Heart of Addiction, Breaking Addiction: A 7-Step Handbook for Ending Any Addiction and The Sober Truth, have been described as revolutionary advances in understanding how addictions work. Full Bio.
I am a recovering alcoholic and have been sober for 3 years, 3 months and 8 days. I am also a mum, a wife and a professional. Because of my life and responsibilities I have done much of the work to get sober from home: online (your website is an enormous help to me) and through reading at the library. I have wanted to attend AA but I have small children so it's not possible. My reason for writing today is that in November I have a girls weekend away in another city from where I live. It will be the first time I am away from my children, or my husband for that matter, in sobriety and I am terrified of relapse. It is with friends from childhood, and yes old drinking buddies. Everyone knows I no longer drink but I'm so scared that my brain will just tell me 'go for it' and I'll drink. I truly believe that if I drink again, it will kill me. This situation feels life and death for me and it's making me not want to go on the trip. What advice can you give me on how to handle myself on the trip. I have OCD (the self medication of which led to my addiction) so I'm starting to obsess and all this thinking about drinking is difficult also.
Your help is greatly appreciated. Kind regards - Barbara
Roland Williams: Hi Barbara. Thanks for your question. t’s a tough one actually, so much comes up for me when I read and re-read your email. You seem to have a lot going on and I don’t want to minimize any of these very important issues in my response. So I think it would be easiest for me to break it down into what I am getting from you.
- You are sober and obviously proud of that accomplishment
- You did most of the work to get sober from home, online and reading at the library
- You want to attend AA but it’s not possible
- You have not been away from your children in a long time
- Your first trip away will be with old friends that drink away from your home
- You are afraid that your disease will take over and you might possibly drink
- You believe that if you drink again it will kill you
- You are obsessing about thinking about drinking
When you look at it like this, it looks overwhelming, doesn’t it? In one short paragraph you outlined a series of very complicated issues, each one could be a separate therapy session. So here’s what I think, in order of how you presented it all.
First and foremost, protect your 3 years, 3 months and 8+ days of sobriety, at all costs. I’m sure that your ability to be a mum, a wife and a professional are all contingent on you staying sober. If you drink, your ability to be either and all of those becomes compromised. So your Recovery has to be your number one priority - you need it to do all that other good stuff.
I think it’s great that you were able to get and stay sober primarily from home. However, from your email I can’t determine exactly what your Recovery program looks like in practice. It’s very difficult to achieve Recovery in a vacuum. It’s usually not enough to just stop drinking, because abstinence is not the same as Recovery; it’s a prerequisite for Recovery. It gives you the clarity to do the work you need to do to heal, and I can’t tell what that “Recovery Work” looks like in your life.
I know Recovery is a fluid process and it changes as we change…. we get older, acquire responsibilities etc. and we have to do whatever we can to keep our Recovery program fresh, current, and applicable to our issues. A lot of people are finding themselves challenged by a working a program that was appropriate in year one, but not so appropriate in year five.
The fact that you “want” to do AA is encouraging, and if that’s the case, then I would challenge whether it is truly “not possible.” I believe if you wanted to go, you could make it happen, and that might be one of the updates you need in your Recovery program at this time in your life.
I know a lot of people who don’t want to go to AA. They have many reasons, from philosophical differences, to conflicting schedules, bad experiences, new responsibilities, etc. And certainly a lot of people actually stay sober without AA, but the fact is if you are an alcoholic/addict seeking Recovery and are not going to 12-step meetings, you actually have to work twice as hard to achieve Recovery. AA provides a fellowship, a social network, accountability, a mentor, a set of guidelines for living your life, a sounding board, a routine, a laugh or two and a constant reminder of what to do and what “not to do”… all for free. Without AA a person has to try replicate as many of these things as possible in their lives, and that's not as easy as it sounds.
The fact that you have not been away from your children in I’m not sure how long implies that your life could use a little balance, some mum time, some wife time, some professional time and some Barbara time. It doesn’t seem as if you are getting enough Barbara time. So now you are tempted to go away from the city you live in for a “girls weekend” with women you used to drink with, In Relapse Prevention Therapy, we would refer to that as a “High Risk Situation” and the first rule in dealing with a HRS is to ask yourself “do I have to go?” You see we treat any person, place or thing that poses a threat to our Recovery, the same way Superman would treat Kryptonite.
By your own admission you are afraid that your alcoholic brain will tell you to "go for it," so it sounds risky. I’m not telling you whether or not you should go, that’s your choice, but I wish you were connected to some women in Recovery who you could go and hang out with. It sounds as if you need a break, but I’m not sure if this is the best way for you to get one, I wish you had healthier and safer options.
If you decide to take such a gamble with your Recovery, and I only say this based on the thoughts you are having about going, I think you need a real solid Relapse Prevention Plan, i.e. have your own transportation, call someone everyday and check in, have a drink in your hand at all times, (Coke, soda water, etc). Have a person there that you can tell if things get uncomfortable for you; have your own living area so you can get away from the drinking if you need to, etc.
Don’t underestimate the seriousness of this situation. By your own admission you believe if you drink again it could kill you. So again I challenge you to consider the stakes as you weigh the pros and cons of putting yourself in such a situation, and ask yourself is there a better, safer way for you to have a good time. In the first sentence of your email you describe yourself as a “Recovering” alcoholic, so now is the time to use your Recovery tools.
Finally if your OCD is kicking in and your are obsessing about this… pay attention to your intuition. Listen to that voice inside - it might save your life. I wish you all the best and I would love to hear what you decide to do.
Roland Williams, MA, is an internationally recognized addiction interventionist, author, educator, trainer, counselor and consultant. He heads www.rolandwilliamsconsulting.com and is Director of Clinical Operations at DARA Thailand (www.dararehab.com) and Clinical Director at Lionrock Recovery’s (www.lionrockrecovery.com) Online Intensive Outpatient program. He has provided treatment and program development consultation to major institutions around the world. A popular keynote speaker, he authored Relapse Prevention Counseling for African Americans, Relapse Warning Signs for African Americans (with Terence T. Gorski), and the Relapse Prevention Workbook for African Americans. Full Bio.
My partner has suddenly become very distant and secretive. I suspect something's up. Best way to confront? Should I suggest help? Give an ultimatum? – Chloe.
Doreen Maller: Social withdrawal can be a sign of many things: depression, addiction, a change of heart… and it can be very confusing to partners and loved ones. When a person shuts down and resists connection, it may feel that all attempts to relate seem to drive the person farther away. Often the people closest are the first to detect shifts and changes. These can begin subtly and then move toward the situation you describe. Feeling distance in intimate relationships can be confusing and painful.
Using statements about yourself can start conversations that are less threatening and accusatory which can then lead to a deepening of connection. Therapists call these “I” statements, which means you are speaking from your own experience rather than stating your observations about someone else’s life. Saying, “I’m frightened and confused and concerned,” rather than “You have a problem,” can cut through resistance and provide opportunities for dialogue. Asking your partner to join you for counseling or support can be a good first step. If addiction or abuse is contributing to the secrecy, early treatment and intervention can help connect your partner into a recovery model that works best for them. Getting your own support in the process can be helpful, too.
There are many opinions regarding the efficacy of confrontation and ultimatums. Some suggest that holding the person accountable to solve their own problems is the best approach. Others feel that doing everything in your power to move them toward recovery is a better choice. Ultimately, you may both need support to move through your current situation. Asking your partner to join you in support and sharing the responsibility for education and a plan of action with a professional can reduce tension, and move both of you toward informed choices.
There are many resources online for guidance for these types of concerns. Try: http://newsinhealth.nih.gov/2009/March/feature1.htm
You can contact rehabilitation centers in your area and ask for guidance or set up an appointment with a therapist to discuss your concerns. Mental health care providers can walk you and your partner through the first steps of relationship challenges and education toward recovery. Primary care physicians and clergy are also good resources who can refer you to programs and support.
Shifts and changes in relationships can be isolating and frightening regardless of the cause. Asking for help and support in these times can help build coping skills as well as treatment plans to move both of you toward appropriate services.
Doreen Maller, MFT, PhD, began her practice in community mental health with a specialty in high-risk children and their families, including numerous families coping with addiction issues. Dr. Maller is the series editor of the three-volume Praeger Handbook of Community Mental Health Practice. See www.doreenmaller.com Full Bio.
My husband had an affair for several months with someone he met in rehab. Now he says it's over and he wants to go on like nothing happened. I'm glad he got sober and is now back in AA but I wonder how this could get by his sponsors and whether these character defects are just never going to get fixed in an addict. I am not trusting him and can't forgive him for the infidelity, though I do care about him. I clearly need some guidance here and an overall plan. Do you think this is fixable or should I just move on, given how he has revealed himself. - Laurel
Stacey Rosenfeld: This sounds like a difficult situation, but the good news is, you have a say in how things proceed. I'd conceptualize this as less an addiction issue and more a marital concern at this point. We might debate whether or not someone can recover from a character defect, but what seems more useful is determining if your marriage can recover from this affair.
Does the relationship seem salvageable? Is your husband willing to acknowledge the pain he's caused? Does he seem committed to working on the marriage? What is keeping you in the relationship at this point? What could your husband do, if anything, to earn back your trust over time? These are some questions to consider. A course of couple's counseling might help you and your husband determine whether the relationship is fixable and, if so, guide you through the process. Individual therapy could provide you with support and a place to process your feelings and develop a plan that feels right for you.
Stacey Rosenfeld, PhD, is a clinical psychologist who treats patients with eating disorders, anxiety/depression, substance use issues, and relationship difficulties. A certified group psychotherapist, she has worked at Columbia University Medical Center in NYC and at UCLA in Los Angeles and is a member of three eating disorder associations. The author of the highly- praised Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight, she is often interviewed by media outlets as an expert in the field. www.staceyrosenfeld.com Full Bio.
Our panel of experts. Click for full bios.
|Patrick J. Carnes, PhD, CAS, is the best-known sexual addiction expert in the country. An expert in all addictions, he is the founder of the therapist-training International Institute for Trauma and Addiction Professionals (IITAP) in Arizona, of Gentle Path Press and of the 12-step based Twelve Principles Online Recovery program. He also created the Gentle Path Program, a residential treatment program for sexual addiction.|
|Tessie Castillo is the Advocacy and Communications Coordinator at the North Carolina Harm Reduction Coalition, a leading public health and drug policy reform organization in the Southern United States. She is an expert on harm reduction, overdose prevention and response, naloxone, the drug war, and policy reform.|
|Lance Dodes, MD, has been Director of the substance abuse treatment unit of Harvard’s McLean Hospital, Director of the alcoholism treatment unit at Spaulding Rehabilitation Hospital and Director of the Boston Center for Problem Gambling. His books, The Heart of Addiction, Breaking Addiction: A 7-Step Handbook for Ending Any Addiction and The Sober Truth, have been described as revolutionary advances in understanding how addictions work.|
|Brian Donohue has an MA degree from Long Island University in clinical psychology, and has worked in private practice as a therapist with a loosely Jungian perspective and as a meditation teacher. He has worked with depressed people, anxious people, and people undergoing major life changes, challenges, and crises. See briandonohue.org.|
|Janice Dorn, MD, PhD, specializes in psychiatry, addiction psychiatry and addiction medicine. She holds a PhD in Anatomy and has done extensive research and teaching in brain anatomy and physiology. She is also an expert on addiction to stock trading and on stock trading itself. Her second book, Mind, Money and Markets, with co-author Dave Harder, is scheduled for publication in the fall.|
|Doreen Maller, MFT, PhD, began her practice in community mental health with a specialty in high-risk children and their families, including numerous families coping with addiction issues. Dr. Maller is the series editor of the three-volume Praeger Handbook of Community Mental Health Practice. See www.doreenmaller.com|
|Rita Milios, LCSW, is a psychotherapist in private practice, author of more than 30 books, and frequent professional lecturer and on-camera expert. She also facilitates workshops and training for clinicians, therapists, writers, holistic practitioners, businesses and associations. She is known as "The Mind Mentor" because of her unique approach to “mind tools training.” RitaMilios.linktoexpert.com|
|Larissa Mooney, MD, is the Director of the Addiction Medicine Clinic at University of California, Los Angeles, and is a board certified addiction psychiatrist with expertise in the treatment of substance use disorders and psychiatric co-occurring disorders. She is also Assistant Clinical Professor of Psychiatry at UCLA. www.LarissaMooneyMD.com|
|John C. Norcross, PhD, is the author of the critically acclaimed book Changeology as well as co-writer or editor of 19 other books. He is Distinguished Professor of Psychology at the University of Scranton and Adjunct Professor of Psychiatry at SUNY Upstate Medical University. His ideas have been incorporated into addiction treatment by many therapists.|
|Harold Owens is Senior Director of the MusiCares/MAP FUND, the charity arm of the National Academy of Recording Arts & Sciences (the GRAMMY organization). He is responsible for the implementation of all aspects of the MusiCares addiction recovery program for artists. Earlier, for three years, he was Program Director of The Exodus Recovery Center. He can be reached at email@example.com.|
Stanton Peele, PhD and attorney, is an innovator in the field of addiction, beginning with his breakthrough 1975 book, Love and Addiction (written with Archie Brodsky) and followed by 11 others, most recently Recover! Stop Thinking Like an Addict. He has created his own rehab program (The Life Process Program) for individual substance abusers. See www.peele.net and his Facebook and Twitter.
Stacey Rosenfeld, PhD, is a clinical psychologist who treats patients with eating disorders, anxiety/depression, substance use issues, and relationship difficulties. A certified group psychotherapist, she has worked at Columbia University Medical Center in NYC and at UCLA in Los Angeles and is a member of three eating disorder associations. The author of the highly- praised Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight, she is often interviewed by media outlets as an expert in the field. www.staceyrosenfeld.com
G Jay Westbrook, M.S-Gerontology., R.N, is a multiple award-winning clinician (Nurse of the Year), Visiting Faculty Scholar at Harvard Medical School, speaker and author who specializes in both substance abuse recovery and End-of-Life care and is an expert in Grief Recovery©. He has both consulted to and served as a clinician in multiple treatment centers and hospitals, guiding clients through their grief, and working with them and their families on healing broken relationships. His lectures to physicians and nurses include trainings in When Your Patient is a Substance Abuser: Currently or Historically. He can be reached at CompassionateJourney@hotmail.com.
|Roland Williams, MA, is an internationally recognized addiction interventionist, author, educator, trainer, counselor and consultant. He heads www.rolandwilliamsconsulting.com and is Director of Clinical Operations at DARA Thailand (www.dararehab.com) and Clinical Director at Lionrock Recovery’s (www.lionrockrecovery.com) Online Intensive Outpatient program. He has provided treatment and program development consultation to major institutions around the world. A popular keynote speaker, he authored Relapse Prevention Counseling for African Americans, Relapse Warning Signs for African Americans (with Terence T. Gorski), and the Relapse Prevention Workbook for African Americans.|