It is estimated that 90 percent of alcoholics will undergo at least one relapse over the 4-year period following treatment. Even though it has potentials no studies could confirm that single or combined treatment could prevent relapse. Alcohol relapse is still subject to further study.
Studies show that relapse rates for alcohol, nicotine and heroin addiction show that the mechanism that for works for one may be effective with another addictive disorder due to its common biochemical, behavioral or cognitive components. Combining relapse data for various addictive disorders may offer insights on how to prevent alcohol relapse.
Impaired control is considered as the determining factor for alcoholic relapse. Keller proposed two definitions for impaired control. First, it pertains to unpredictability of alcoholic’s decision to take the first drink and second, his incapacity to stop drinking once he starts. Other researchers limit the definition of impaired control to inability to control drinking after first started. Taking one drink does not necessarily mean it will lead to uncontrolled drinking. Studies reveal that the degree of dependence will determine the ability to stop drinking after the first gulp.
Relapse theories often use the concept of craving. The definition of ‘craving’ though has led to confusion which led some behavioral investigators to conclude that craving is meaningless and it points to the main reason that the subject drinks. They prefer to focus on the behavior of drinking and the influence the environment play to stimulate the alcohol disorder.
Craving for Alcohol
Ludwig and Stark however believed otherwise. They believe craving or physiological urges could be a factor. They believe that the way to determine craving is by simply asking if the person who has not yet drink alcohol develops urges for it, the way a person feels hunger before eating. Ludwig and colleagues points out that alcoholics could experience conditioning by combining external and internal factors that strengthen the effects of alcohol.
Their concept on alcoholism implies that alcohol craving is liken to an urge stimulated by appetite such as hunger that differs in degrees and could demonstrate symptoms similar to withdrawal. The symptoms are caused by the internal and external signals that prompt past memories of euphoria caused by alcohol and the distress caused by withdrawal.
Behavioral Prevention and Pharmacological Strategies
Studies have been conducted to determine the physiological responses brought about by alcohol cues. Research shows that mere exposure to alcohol without drinking could stimulate salivary responses in alcoholics.
Skin conductance levels and desire for alcohol are used to determine the effects of alcohol cues, it was found out that these factors are most prominent in people whose dependence on alcohol is serious. A placebo beer was used to test the reactions of alcoholics from non-alcoholics. The result shows a greater and faster insulin and glucose responses for the alcoholics.
To address relapse problems, some relapse prevention models are combined with the idea of self-efficacy or the assessment of the person on his/her capacity to succeed in alcohol withdrawal. According to Marlatt and associates the progression of the first drink to abstinence to excessive drinking is determined by the person’s experience and reaction brought about by the first drink.
Researchers are able to come up with a cognitive-behavioral analysis of relapse, there are four factors which influence relapse: exposure to high-risk environmental situations, skills or ability to cope with high-risk situations, degree of estimated personal control (self-efficacy) and the expected affirmative effects of alcohol.
The high-risk situations associated with relapse are the following: 1. frustration and anger, 2. social pressure and 3. interpersonal temptation. Cooney and colleagues pointed out that exposure to alcohol signals could lead to decrease in their confidence in their ability to deal with the drinking problem.
One of the ways to counter relapse, alcoholics must take an active role and make a conscious effort in modifying their attitude towards drinking. They must establish three basic rules: change lifestyle to be able to increase the capacity to deal with stress and high-risk situations effectively; recognize and respond properly to internal and external signals that serve as relapse warnings; and practice self-control techniques in any situation.
Chaney and colleagues attempted to determine the effectiveness of skills-training intervention to help alcoholics who has experienced relapse or those at risk for relapse. The alcoholics were taught problem-solving techniques and practiced ways of conducting themselves when confronted with high-risks situations. Researchers believe that skills training could be an essential part in using multimodal behavioral approach in thwarting a relapse.
A good relapse prevention standard will require the need for a technique that aids individuals to develop a description of drinking behavior in the past and the present expectations when it comes to high-risk situations. The therapy should use coping techniques coupled with behavioral change through giving the client performance-based homework that exposes him to high-risk situations.
The result in this kind of therapy showed a lesser number of drinks taken per day and lesser number of drinking days in a week’s time. A remarkable 47% of the clients demonstrated total abstinence in a span of 3-months and 29% reported total abstinence for a length of 6months.
Decreased Serotonin and Craving
Aside from therapy sessions, Disulfiram (Antabuse) is used to complement and increase the chance of much longer sobriety. Sometimes patients’ inability to take the medicine on time could pose an obstacle, still disulfiram therapy is able to effectively lessen the frequency of drinking in alchoholics who could not abstain totally. Research was conducted on disulfiram administration under strict supervision and results showed that a long period of sobriety for 12 months is noticed in patients who took the medication.
Neurochemical studies also showed that lower levels of brain serotonin may affect cravings for alcohol. In rats, those who preferred alcohol showed lower levels of serotonin in various parts of the brain. In rodents, drugs that enhance brain serotonin activity effectively lessen alcohol consumption.
Four separate research were conducted to determine the effect of serotonin blockers -zimelidine, citalopram, and fluoxetine on alcohol intake in humans, each utilizes double-blind, placebo-controlled format. These agents proved to effectively lessen alcohol consumption and, in some cases, a remarkable increase in the number of abstinent days. These effects, however, were found in small quantities and were short termed. More clinical trials in a more controlled and larger number of subjects need to be done before serotonin blockers can be proven for relapse prevention. In both pharmacological and behavioral prevention strategies however, it is imperative to take into account the degree of alcohol dependence as a vital factor.