Patients with alcohol use disorders who receive more aggressive treatment were only slightly more successful in abstaining from drinking, according to a study in the Sept. 18 issue of the Journal of the American Medical Association, JAMA.
Chronic care management (CCM).including relapse prevention counseling and medical, addiction and psychiatric care, was only slightly more successful after 12 months than usual primary care consisting of a timely office visit and a list of counseling resources in the community.
CCM is a way of delivering care that has been shown to be effective for other chronic medical and mental health conditions. Trials integrating medical and addiction attention suggest that CCM may be effective for treating alcoholism, particularly since elements long known to be effective for addiction overlap with CCM approaches. But the study proved only small differences between the approaches.
Lead author of the study, Richard Saitz, M.D., of Boston Medical Center, found no difference in abstinence between the CCM intervention and the primary care approach, 44 percent vs. 42 percent, respectively. The result was for dependence for all drugs.
In a subgroup of patients with alcoholism, “there were fewer alcohol problems” among those who received the CCM approach. “Even though CCM is effective for a number of chronic conditions, it may be premature to assume that CCM will be the solution to improve the quality of care for and reduce costs of patients with addiction,” said Saitz.
“Further research is warranted to determine whether more intensive or longer-duration CCM, or CCM designed differently, might do so,” he concluded.
In a related JAMA editorial, Patrick G. O’Connor, M.D., of the Yale University School of Medicine, agreed, saying the study results suggest the glass is half full rather than half empty. “This study places the evaluation of CCM for the treatment of substance use disorders firmly on the agenda for future research. The CCM concept is sound, at least for some chronic illnesses, and highly relevant to today’s evolving health care system. Comprehensive, integrated management of addiction can only benefit patients—it remains to be seen how best to deliver substance abuse treatment effectively in an evidence-based manner.”
The disease of alcoholism is noted for its high rate of relapse. The 2013 book Every Silver Lining Has a Cloud: Relapse and the Symptoms of Sobriety cites relapse rates as high as 90 percent within five years of stopping drinking.
“Relapse is considered by alcohologists to be part of the recovery process, yet some cynically state that relapse isn’t part of recovery it’s part of drinking. The high rate of lapse (or relapse) isn’t even unique to Alcoholics. People with chronic depression have a relapse rate also at 50-80 percent. High blood pressure patients only have to keep taking their meds—a really simple task compared to staying clear of alcohol—and their rate of non-compliance is as high. Patients with seizure disorders: Same thing. Diabetics, too.”
Terence Gorski, author of Staying Sober, is the pioneer of the Relapse Prevention Protocol and he believes “you cannot experience recovery without experiencing a tendency toward relapse.”
Louise Bailey Burgess, author of Alcohol and Your Health, adds, “Unfortunately, despite desperate determination, the depressing fact remains that not more than 50 percent of those who decide to quit, manage to attain sobriety for the rest of their lives.”
Neuroscientist George Koob of the Scripps Research Institute, in "Moyers on Addiction: Close to Home," puts the number at 80 percent of those who have detoxed relapsing within a year. Yet another expert, Michael Dennis of Chestnut Health Systems says in HBO's, "Addiction: Why Can’t They Just Stop?"
“Seventy percent of patients relapse after the first time getting help. It’s not like fixing a broken bone.”