AUD is a chronic disease with dire consequences if left untreated or unabated. The CDC reports that, from 2015–2019, excessive alcohol use led to more than 140,000 deaths and 3.6 million years of potential life lost (YPLL). Those who died missed out an average of 26 additional years.
The CDC also tell us that the economic costs of excessive alcohol consumption in 2010 were an estimated $249 billion. That works out to be $2.05 a drink.
AUD destroys health, careers, and loving relationships. That’s why it’s often so hard to understand why someone keeps drinking, seemingly oblivious or indifferent to the chaos around them. It’s also why so many loved ones also suffer physical and mental damage struggling to deal with anger, anxiety and despair.
Myths abound about AUD. It’s important to examine them. As is true with any disease or behavioral disorder, we can’t begin to solve or change it if we don’t fully understand and accept it.
Let’s knock down a few misconceptions:
“The person with AUD can stop, he/she/they just choose not to do so.”
Set aside emotional reactions and focus instead on neuroscience. Physiological and psychological factors act like the chicken and the egg of addiction. The brain of someone with AUD functions differently than that of a person without the disorder. AUD diminishes the ability to feel pleasure or even general satisfaction without the chemical rush (dopamine) induced by alcohol. And, it has an opposite effect too, significantly hindering the capacity to successfully navigate daily stresses (again chemistry is at play).
Withdrawal kicks in too. People with AUD come to fear the sometime extreme physical pain and side effects like uncontrollable shaking that can occur when trying to abstain. Finally, the pre-frontal cortex, the brain region critical to making reasoned, logical decisions, is diminished by AUD.
If AUD were baseball, every addicted batter chalks up three strikes before stepping up to the plate. No wonder most give up before the next pitch.
That said, as noted in a Surgeon General’s report from 2016:
… substance use disorders are said to involve compromised self-control. It is not a complete loss of autonomy—addicted individuals are still accountable for their actions—but they are much less able to override the powerful drive to seek relief from withdrawal provided by alcohol or drugs. At every turn, people with addictions who try to quit find their resolve challenged. Even if they can resist drug or alcohol use for a while, at some point the constant craving triggered by the many cues in their life may erode their resolve, resulting in a return to substance use, or relapse.
“Relapse is failure and indicates that the person with AUD will never maintain recovery.”
In our experience at Maryhaven and, again, as demonstrated by research, relapse may not be welcomed, but it can be a normal part of recovery. Surveys from the National Institute on Alcohol Abuse and Alcoholism posit that roughly 90% of people with alcoholism relapse within 4 years after completing treatment.
If someone suffers from other chronic diseases like hypertension or high blood pressure, we don’t assume they will never improve if they slip and eat highly salty foods or miss taking their medicine. Maryhaven staff see people every day who have relapsed and are again trying to return to recovery. While current research makes it difficult to make conclusive statements, it appears that most people relapse about five times on average before achieving long-term sobriety. Recovery should be seen more like a marathon than a sprint.
“Not everyone with AUD needs treatment and long-term supports.”
Every person certainly is different, genetically and environmentally. Further, just because someone abuses alcohol for a certain period of time, that doesn’t necessarily translate into full-blown addiction. That’s why the Diagnostic and Statistical Manual of Mental Health Disorders (DSM) carefully defines what constitutes addiction. Some of the key determinants include tolerance or the need for greater quantities to generate the intended effect, withdrawal, the overwhelming need to drink again, and other factors such as the willingness to keep drinking despite knowing how much it is wrecking your life.
So, while every treatment strategy is tailored to the individual client, the vast majority of people with diagnosed AUD typically need intervention, detoxification on an inpatient basis, treatment options ranging from medication, individual or group therapy, and other recovery supports such as peer groups or digital apps. Again, we don’t hesitate to assertively manage other chronic illnesses by following accepted medical practices. AUD isn’t different.
One final note: Data from SAMSHA’s 2018 Survey on drug use found that about 9.2 million people in the U.S. experienced what’s known as a co-occurring disorder, or a dual disorder along with AUD. These issues typically are depression or anxiety. Without treatment, either condition can feed the desire to drink and cause the entire downward spiral of addiction to unfold again. It’s important to proactively work on both disorders to achieve long-term sobriety and a more complete recovery to a happy, productive life.
Treatment strategies for AUD Used by Maryhaven
People who seek to detox or withdraw safely from an Alcohol Use Disorder typically come to Maryhaven by referral from an approved referral partner or as a walk-in.
No matter how clients find us, our team meet with each person. Together, we:
— Screen for critical needs that affect the treatment process. If someone has seizure disorders, significant medial issues, or is psychiatrically unstable due to hallucinations or suicide ideation, they may be better served in a different treatment center. We will offer every client options to secure a right fit for their care.
— Assess health risks. Anyone with a blood alcohol level of 0.3 or higher will be deferred from admission to Maryhaven until blood alcohol content has been reduced in a hospital setting. This step protects clients at high risk of experiencing alcohol-related seizures.
— Sign consent forms, verify insurance and/or apply for Medicaid. Though we certainly want to find funding as appropriate, Maryhaven treats everyone, regardless of ability to pay.
— Complete a medical evaluation and assess each client’s ability to provide self-care. A nurse and other health care professional conducts a medical evaluation and physical. Part of this screening is determining how much self-care a client can administer. This step results in a personalized treatment regime that will best benefit each client.
Medications: As noted previously, helping the body rid itself of alcohol can be a challenging and uncomfortable process. It requires proper medical care and oversight, especially to avoid issues or respond to what can be life-threatening events like seizures.
Some medications can help manage withdrawal symptoms, which may include sweating, nausea, vomiting, tremors and a rapid heartbeat. Maryhaven relies on Ativan, a benzodiazepine, for alcohol withdrawal.
Ativan is widely used for a number of conditions and can be very effective in easing alcohol withdrawal symptoms because it affects the same neurotransmitter affected by alcohol.
Our treatment team will determine whether and what dose of Ativan is best for each client based upon a scale called the Clinical Institute Withdrawal Assessment. This tool estimates the severity of symptoms a person may face during detox and is part of a best practice protocol advising behavioral and physical health professionals. If a client receives Ativan, he or she will be reassessed at regular intervals and the dosages of the drug will be tapered down as the individual progresses through treatment.
Some clients never receive Ativan as the assessment indicated it was unnecessary for them to complete their detox. Those who do receive it may spend more time in detox as they will not be released until at least 24 hours after their last dose of Ativan.
Overall Treatment: As clients progress through their withdrawal, each meets daily with a clinician. Together, they develop a plan for the next steps of treatment, whether in-patient or residential care or out-patient, medically supervised care. In addition, clients meet daily with a behavioral health professional to begin best-practice mental health treatments such as Cognitive Behavioral Therapy.
Additional Guidelines to Know
Maryhaven currently oversees a total of 57 beds for adults 18 or older in our withdrawal management unit, a co-ed facility located on South High Street in Columbus. We work hard and are proud to share that nearly all clients can enter detox on the same day they sought treatment.
Maryhaven provides clean scrubs and daily meals while in detox. Clients can:
— exit at any point in the process, although those who enter detox under court order must be medically cleared and have an after-care process in place for the court to approve their exit.
— bring medications with them, except the Drug Enforcement Agency will not permit us to hold any scheduled narcotics such as Suboxone.
— pack sweatshirts, undergarments or socks to wear with the scrubs provided by Maryhaven’s team.
— carry up to $30 cash for vending machines for additional food, snacks or beverages.
We can’t allow personal cell phones while in the facility.
Since January 1, 2022 more than two-thirds of Maryhaven detox clients stepped down to less intensive care (either an in- or out-patient treatment program). In 2021, we served 3,800 clients.