By April Wilson Smith, MPH & Lisa Chiodo, PhD
Patients, families, and friends (we like to call family and friends “allies”) come to Alcohol Use Disorder (AUD) treatment with some big expectations. The media has popularized the notion of rehab as a place that “fixes” people. It’s kind of like getting your car serviced; drop it off at the shop, pay your money, and your car is running like new!
That’s not how treatment works. It’s possible that the abysmal failure rates of traditional inpatient rehab are in part due to unrealistic expectations. People are not machines; they must heal, adjust, and grow. In treatment, we don’t just tighten a few screws, change the oil, and send a patient on their way. Sometimes, things get even harder as issues that were masked by alcohol use rise to the surface.
So, what are allies supposed to expect? We’ve gathered this primer on what to expect when your loved one is in treatment in the hopes that it will help you navigate this challenging and exciting time.
Question: Why is my loved one still drinking?
Answer: Stopping alcohol use abruptly can be extremely dangerous, even deadly, if someone has been drinking heavily for some time. The consequences of suddenly stopping alcohol include seizure, high blood pressure, stroke, heart attack, severe anxiety, and delirium. Our absolute top priority is patient safety. At North-Star Care, we guide patients through a highly structured, medically supervised alcohol taper process. We assess current alcohol levels with remote monitoring systems and design a taper that is individualized to each patient’s unique need.
During the taper, your loved one will continue to drink. Please keep in mind that by drinking, they are following their doctor’s orders. They are gradually reducing the amount of alcohol so that they can stay safe. Whether their eventual goal is abstinence (no alcohol at all) or moderation (drinking at safe levels that do not interfere with their lives), decreasing the amount of alcohol consumed must be done slowly and carefully. Through this approach, most patients do not require inpatient Detox and can reduce their alcohol use privately and gradually in their home. Think about the last time you stopped any medication or drug. Did you do it abruptly? Probably not. Doctors even taper patients off blood pressure medication because it is not safe to just stop. Why do people think it is safe to immediately stop alcohol? It is not!
Patients will still experience symptoms of alcohol withdrawal during the taper process. However, these symptoms will be mild and not dangerous. Symptoms may include anxiety, sadness, difficulty sleeping, jumpiness, slight shakiness, and irritability. These are temporary and will abate gradually but may go up and down during the taper. You can support your loved one by assuring them that anxiety is normal and reminding them that their North-Star Care team is always available to coach them through this process. We want our patients to reach out.
If your loved one asks for help along the way, it is wonderful to help, but avoid managing and dictating. We have observed that when loved ones attempt to manage a taper without being asked, patients feel more stress leading to challenges maintaining the taper schedule. It’s best to follow your loved one’s lead on this. It may be jarring to see your loved one drink while in treatment but letting them manage this process in consultation with their care team will pay off.
This is an important time to take care of you too. Take advantage of the fact that your loved one is getting support from the North-Star Care team and be sure that you are taking the time you need to take a walk, catch up on work, reconnect with your own friends and activities you enjoy. Allies are often burnt out from caring for a person with AUD by the time that person begins treatment. It’s time to start realigning the relationship so that you are meeting your own needs too!
Question: Why do you let my loved one choose moderation? I thought “alcoholics” could never drink again.
Answer: The requirement to commit to permanent abstinence is one of the major barriers to seeking treatment. 40% of people suffering from AUD do not seek treatment because they do not want to commit to never drink again. We know that this barrier is unnecessary, and we work with patients to create goals that will help them achieve their best life.
At North-Star Care, we base our treatment philosophy on scientific evidence about how Alcohol Use Disorder works. Contrary to popular mythology, people who have once had problematic alcohol use do not have to be abstinent forever to be healthy. Some choose long term abstinence, but many can successfully moderate their alcohol use.
Question: What if my loved one has decided on abstinence, and then they have a drink?
Answer: Return to use, even if a person has chosen abstinence, is very common. At North-Star Care, we know how important the support of family and friends are when a person struggles with their goals. We foster a “no shame, no blame” attitude, and encourage our patients to learn from their experiences and make plans to weather future challenges, not beat themselves up.
It can be frustrating for loved ones to see a patient in treatment pick up a drink. We understand, and we offer education and support for allies to understand this process. When allies react in a supportive, non-judgmental manner, patients get back on track; when allies are critical and punitive, patients struggle. We try to educate allies so that they can help patients stay the course, and not turn one slip into a catastrophe.
Read more here: https://northstarcare.com/he-drank-again/
Question: Inpatient rehabs watch patients round the clock so they can’t have access to alcohol. Should I monitor my loved one’s activities, so I know they are not drinking?
Answer: No. One of the most damaging aspects of traditional rehab is that it makes patients think they must be kept under lock and key because they cannot control themselves. This is humiliating and sets the patient up for failure when the locked doors are no longer there.
Loved ones should never be put in the position of watchdogs. That sets up an adversarial dynamic that makes everyone uncomfortable. Even if you are the parent of an adult patient, remember they should be encouraged to make their own decisions. If they ask for help, such as asking you to keep alcohol out of the house, please oblige. If they do not ask for help, you do not need to be their protector or guardian.
Question: Before we go out, for example to visit family, should I tell others that my loved one is in treatment and cannot be around alcohol?
Answer: No. It is your loved one’s decision who to tell and who not to tell. The healing process is often derailed by unwelcome sharing of this private information. If your loved one wants your help in telling others, they will ask.
Question: What if there is alcohol at a gathering?
Answer: Let your loved one handle the situation the way they choose. One of the worst things a person can hear is, “You can’t have that!” No one wants to be treated like a child, especially in front of friends or family. The treatment team at North-Star Care works hard with patients to devise strategies for handling gatherings where alcohol may be present.
Question: How long will it take for my loved one to be better?
Answer: At NorthStar Care, we provide a treatment for at least one year. During the year, you can be assured that your loved one will get the best possible medical care, nutritional support, and support from peers with lived experience who have learned how to restore their health. This will not be a linear process; there are ups and downs. Patients’ goals often change as time goes on.
Traditional rehab promises a quick fix to patients and families returning them as new and improved versions of their former selves. At NorthStar Care we know that this is not how it works. People change as they emerge from AUD. They may discover aspects of their personalities that have been hidden. Old conflicts may surface. They may not enjoy things they used to love to do and may gain interest in new activities.
Throughout this process, we provide ally support to help you understand what’s happening and improve your life as your loved one improves theirs. There is no cookie-cutter answer to how long this will take. Every step along the way is an opportunity for learning. Even after a year of treatment, a patient will still face challenges. During the year of treatment, they will develop strategies for coping and staying well.
Question: What can I do to support my loved one?
Answer: You’re doing it! You’re reading this article, asking the question, and being involved.
Each person has different wants and needs for support, and each ally has different ways of relating. At North-Star Care, we have a division of Ally and Family Support, just to help allies and family members through this process. We can schedule a meeting with allies to discuss care and answer questions. The patient’s privacy is always protected, and nothing happens without the request of the patient, so all are included and feel safe.
If you’ve been spending a great deal of your time and emotional energy trying to help a loved one through an alcohol-related crisis, you are probably tired. The North-Star Care team includes at least five providers who are here to support your loved one. Our clinicians, including MDs, advanced practice clinicians, and nurses, help your loved one get medically stable and speed up the brain healing process that is so important to wellness. Our Peer Guide team, individuals with lived experience of AUD, provide social support to your loved one as they journey to health. Finally, we have navigators who provide care coordination both within and outside of North-Star Care.
There is no magic to AUD treatment. No one has a pill that someone can take and be “cured.” It takes work, kindness, love, and non-judgmental support to see a person through the process of healing. North-Star Care’s team is here to help you and your loved one achieve the bright future you all deserve.