“He Drank Again”

“He Drank Again”

By April Wilson Smith, MPH and Amanda L. Wilson, MD

Few words are as scary to loved ones of people in Alcohol Use Disorder treatment as “He/she/they drank again.”  Seeing a loved one consume a substance that has caused harm to themselves or others can bring up upsetting memories and frightening visions of the future. 


Yet we know that a return to use of alcohol, even if a person’s goal is abstinence, is way more common than not.  We also know that not everyone’s goal is to be completely abstinent, and that many can learn how to drink safely and in moderation, with the proper tools and support.   


We have been so programmed by the dominant paradigm to believe that one sip of alcohol signifies a failure that we turn a natural occurrence into a catastrophe.  Imagine two responses to the following scenario: A person who has been in AUD treatment for six weeks has an extremely stressful experience, has a few drinks at a familiar bar, then calls a close family member to talk. 


Response 1: The family member freaks out, tells the person that they are extremely disappointed and can’t trust them anymore, and that their AUD treatment is obviously not working.   


Response 2: The family member says, “This is bound to happen.  It’s great that you stopped and reached out to me.  Tomorrow is a new day to get back on track.  I’d love it if you’d call me when the stress hits and before you take a drink next time.” 


Which scenario is more likely to lead to long term success?  Which response is more likely to result in a call before drinking starts?   


Almost anyone who has suffered from AUD or cared about someone who does has seen a cycle: abstinence, binge, regret, remorse, recrimination, rinse, and repeat.  Something isn’t working, but which part? 


It is understandable that friends and family members fear news that their loved one has been drinking.  When they experience this fear, it may help to reach out to their own support system (something severely lacking for people whose lives are disrupted by AUD) for help in processing feelings of fear, disappointment, and even anger.  When family and friends who are impacted by AUD receive support, these caregivers are now better able to provide love, compassion, and understanding when needed.    


Why do people with AUD drink again?  At North-Star Care, we do not buy into the false notion that “Once an alcoholic, always an alcoholic,” or that character defects cause AUD.  What we do know is that for someone whose main coping mechanism is alcohol, it is hard to cope without drinking until new coping strategies are developed.  We work hard with patients and their support system (Allies) to develop these new strategies – including reaching out to allies when in need.  If Ally support is withdrawn when a patient drinks, the problem usually gets worse, not better. 


Alcoholics Anonymous encourages people to count their days, months, and years without alcohol, proudly announce them, and take pride in them.  If a person in AA has a drink (or by some extreme views, even has a bite of pie with liqueur cooked in!), they “lose their time,” even if they had not had a drink in decades.  The shame evident in the eyes of those who have lost their time is painful to witness.  No difference is seen between having one glass of wine, or one night of drinking, or going on a full-blown bender.  Is it any wonder that many people go all the way to a dangerous or life-threatening binge after having that one drink?  


North-Star’s approach is completely different.  We know that return to use is the norm, not the exception.  We do not judge a patient by their number of days alcohol free.  A slip is an opportunity for learning, not a cause for shame and despair.  What happened this time?  What can we do differently in the future?  What skills can we develop to handle life’s challenges without problematic alcohol use? 


When family and friends can understand the difficulty of coping without the familiar solution, and offer support instead of judgment and disappointment, the person is much more able to bounce back from a divergence of their goals.   


When someone whose goal is abstinence has a drink, the shame is horrible.  I cannot count the number of times I’ve heard, “I’m a failure,” from a person in this situation.  Those words were a running soundtrack in my head for years, bolstered by the people in AA and in my family who wondered why I couldn’t “get with it.”  The feelings of failure did not motivate me to learn new coping skills . These feelings of failure just fueled my walk to the corner bar.  The deeper I sank into despair, the more dangerous my drinking became.  One day I passed out at the corner bar and woke up on a ventilator in the hospital.  There was no North-Star Care at the time, and I could not access treatment that provided medical care in a kind, non-judgmental environment and also provided support from people with lived experience.   


What kept me going was unfailing support from family members who learned the hard way that shame and blame does not work.  I learned from many attempts how to manage my stress and anxiety without alcohol.  It’s not easy, but support makes it possible.  


Love and compassion can stop a sip of wine from becoming a binge.  It gives a person the strength to learn and grow, not give up.  It’s not easy for family members and friends to ride the waves of good and bad days, but it makes all the difference.  At North-Star Care, we provide the education and support that allies need to help their loved one achieve their goals.  A momentary return to use can be just one more step on the ladder to wellness.

April Wilson Smith, MHP

April Wilson Smith, MHP

April Wilson Smith, MPH, is the Director of the Peer Guide Program for North Star Care, an innovative health care company that provides telehealth harm reduction-based treatment for people with alcohol use disorder. She is a longtime member and former director of organizational development for Harm Reduction, Abstinence, and Moderation Support (HAMS), a 10,000 member worldwide, online group of people who want to change their drinking. She holds a Masters in public health from Thomas Jefferson University and presented her thesis work at the Harm Reduction Coalition’s 2016 national meeting.