Monthly Archives: March 2013

Why the need for certainty ?

The need for certainty in life may often present itself as a need for total security or total safety, and may seem a very natural and obvious need that many people strive for.

When dealing with alcoholism and people who have entered a rehab, this question of the need for certainty takes on a very different context.

There are two specific areas of concern that need to be addressed upon entering a rehab.

Firstly is where this need for a total sense of certainty has come from, and secondly what this supposed need has led the alcoholic to become in terms of their attitudes and behaviours.

Whilst there are no statistics to back this up, there is a general acknowledgement amongst the world of people who work in alcoholism, and people in AA, that a significant number of alcoholics were born into and/or grew up in alcoholic homes.

An alcoholic home, as a general term, refers to a home where one or more of the parents or even possibly grandparents or significant others were or are active alcoholics.

The importance of this, is the effect it has on the alcoholic themselves, both in childhood and much later in adult life.

The nature of growing up in an alcoholic home for most people manifests itself in the feeling of a lack of safety, a lack of certainty about anything.

This lack of permanence leads the child or kid to crave some level of safety, security or certainty.

They will often take this need for safety or certainty to extreme levels, often to areas where they feel they have some level of control over.

When entering a rehab many years later, that feeling of certainty safety and control will most likely have evaporated.

Obviously this need for certainty is not restricted to people who have grown up in alcoholic homes. Any child who has grown up in a home where parents have not provided that sense of safety for whatever reason will have similar issues.

Whilst this may not cause a person to drink or become addicted to substances, this lack of safety or certainty will provide a huge emotional drive for that person to try and provide that sense of safety for themselves.

This virtually always manifests itself in a need for certainty, which is itself an illusion.

Part of the job of a rehab is, in a very short period of time, provide some of the insights into the emotional drives of the alcoholic that can help them come to terms with their illness, and help begin the process of freeing them from some of the more destructive elements of those emotional drives.

The willingness to look at these things has to come from within the person themselves, and often the time spent in a rehab is too short to really come to terms with that. In that context the people who work in a rehab, in a therapeutic nature, will realise that the most they can do is provide some context for the alcoholic, without giving them a belief that those conditions caused them to drink.

It is always difficult to generalise about what a rehab should or should not do, but it is certainly true to say that the very nature of a rehab does provide some temporary certainty, albeit for a short period of time.

This period of time can be best used at different levels by different people.

The effectiveness of the work done in a rehab, both therapeutically and spiritually, will depends to a large extent on the approach taken by the alcoholic entering a rehab, and by the people who work there.

The benefit of that work or its effectiveness will not be known for probably quite a while after the person has left rehab, and hopefully been able to rebuild their inner world within a safe environment where they have been able to stay sober.

What is trust in God?

The concept of trusting God begins for most people in childhood, with a sense that it adds a level of safety to the safety that a child hopefully feels within their family.

It is unlikely to be spelt out in detail what this means, but will most likely be a felt sense of trust that is more likely to be seen as an extension of a sense of trust or safety that already exists within the family.

The nation of trusting in God will be reinforced by the by such rituals as night-time prayers, going to church, Sunday school, Bible reading etc.

In other scenarios many families and many parents verge on somewhat of the religious neurotic, and use the notion of God as an image almost to escape their own lack of a sense of safety or the ability to provide an emotionally safe environment for their children. In this context the notion of trusting in God takes on a very different meaning, a more sinister one in affect.

When entering a rehab, as when first attending meetings of Alcoholics Anonymous or Narcotics Anonymous, many people are confronted with the word God, and the implications that this word brings up in them, normally as a legacy of their childhood experience.

A rehab will most likely promote the 12 step programme of Alcoholics Anonymous, which is by its very nature focuses on the world of the spirit and of God.

A rehab will have many different approaches to how it deals with people’s antagonism or outright hatred of religion, or any meaning of the word God.

This will be a huge part of a person’s recovery, not least because many people entering a rehab will feel they have lost their sense of choice about what they do.

If a rehab focuses on telling people that they are effectively need to disempower themselves even more by relying on some sense of God that does not work for them, they will merely deepen that sense of hopelessness that the alcoholic is likely to feel on entering a rehab.

A rehab is likely to focus on the first five steps of Alcoholics Anonymous, although the interpretation of what they mean is often significantly different to that which the AA program actually refers.

What will arise, is the question of what trusting in God actually means, and how an alcoholic can begin that process.

This will inevitably raise the question of what the word God means for the alcoholic, and hopefully a rehab will be sensitive to this and help a person explore the different meanings open to them.

The book Alcoholics Anonymous, on which the Fellowship of AA is based, makes continual references to God, spiritual experience, spiritual awakening etc.

At the same time the book does not try to define what these terms means, but makes it pretty clear that it should be a freedom for the individual to discover what these terms mean to them.

It should be a big part of the function of a rehab to reinforce this freedom, although sadly this is not always the case.

The other thing that the big book of Alcoholics Anonymous continually implies, is that a sense of God or of spirit is primarily to be found within the person themselves rather than externally.

This gets to the whole question of the nature of God etc which is much better left alone, in this context.

A big part of the function of a rehab is to provide a safe environment, where an alcoholic can begin the process of rebuilding their life and their inner world.

Learning to trust in God, primarily means learning to trust in themselves first, and using that as a freedom to discover what God means to them, and what trusting in that God actually means.

A rehab should encourage this freedom, even though it obviously brings a level of uncertainty with it, a position that a rehab might find uncomfortable given its very structured and focused environment.

How do you rebuild trust ?

There is an implication in the question, that trust has been broken in some way and needs to be rebuilt by one or two parties.

The whole question of trust and what it means to people is a hugely important one in recovery, as in life generally. In childhood, ideally a child will learn to trust the significant adults in their lives.

A child will think of this in terms of safety rather than the adult concept of trust. A child hopefully will feel safe with an adult, and in some sense that will free them to be themselves and have what they consider to be a safe relationship with that adult.

As adults, we tend to talk about trusting or not trusting people rather than feeling safe with them.

Trust in many ways is a very natural process, although we often tend to talk about distrusting people rather than trusting people.

We tend to make judgements about who we trust and who we don’t trust based on our instincts.

Sometimes these instincts are right and at other times they let us down.Entering a rehab will normally make an alcoholic assume that their instincts and their need for safety has completely deserted them.

And then there is God.

What people mean when they say that they trust God can have a huge number of different interpretations.

For some people it is about trusting an unknown sort of supernatural force who is in control of life.

For other people it is about trusting some type of energy in the universe, and for others it is about trusting God within ourselves.

There are of course other meanings and interpretations. What is rarely talked about, but is key to rebuilding trust is the notion of trusting yourself, which is a key issue for someone entering into a rehab.

An alcoholic will have most likely destroyed trust in themselves, people close to them, family and work colleagues and other people in their lives. It is unlikely they will have done this deliberately, though in certain cases that could well be true.

It is more likely that they have destroyed trust almost as a by product of their need to drink, and to construct a life where they feel safe enough to drink and to be able to get away with it.

This inevitably will have consequences, sometimes severe, both for the alcoholic and for the people close to them.

In a rehab, the process of rebuilding the life of an alcoholic should hopefully start to take place. At some level an alcoholic is likely to feel threatened in a rehab, simply because they are likely to feel under attack, either about their drinking or their life as a result of the drinking.

A rehab may talk about the issue of trust or not, but indirectly it will begin to address the issue of safety within the alcoholic.The notion of beginning to trust yourself normally begins for most of us in childhood, and hopefully becomes a natural part of our lives.

For an alcoholic entering into a rehab, the whole process of rebuilding their lives is about to enter a new phase.

A rehab should have enough of a structure and a wide enough range of therapeutic techniques to begin the process of helping the alcoholic to begin to rediscover themselves as a person.

This will involve understanding at some level the nature of the illness and why there are in a rehab, and what they can do to begin to heal the inner conflicts which will have been a major drive, emotionally, in their alcoholism.

Research into high energy levels and alcoholism

Research into why people drink excessively, become alcoholics, or simply heavy drinkers with an alcohol problem (if there is such a thing) is a hugely complex area because of the diverse nature of people, alcohol and the effects of alcohol on people.

This piece of research done at Yale, and published in the Journal of Clinical Investigation, is potentially very significant because it identifies one of the factors that most alcoholics in recovery would confirm – that alcohol can induce a sense of energy to the brain. In the book Alcoholics Anonymous, a doctor writes something to the effect that alcoholics drink because they like the sensation that alcohol effects within them.

It is certainly true that alcohol can produce a different effect internally on alcoholics that it does not affect on people who are not alcoholics. Understanding what that effect is and how it contributes to the illness of alcoholism is hugely important. This piece of research could make a significant contribution to that evolving debate.

The research is titled

Increased brain uptake and oxidation of acetate in heavy drinkers


‘When a person consumes ethanol, the body quickly begins to convert it to acetic acid, which circulates in the blood and can serve as a source of energy for the brain and other organs. This study used  13C magnetic resonance spectroscopy to test whether chronic heavy drinking is associated with greater brain uptake and oxidation of acetic acid, providing a potential metabolic reward or adenosinergic effect as a consequence of drinking.

Seven heavy drinkers, who regularly consumed at least 8 drinks per week and at least 4 drinks per day at least once per week, and 7 light drinkers, who consumed fewer than 2 drinks per week were recruited. The subjects were administered [2-13C]acetate for 2 hours and scanned throughout that time with magnetic resonance spectroscopy of the brain to observe natural  13C abundance of N-acetylaspartate (NAA) and the appearance of13C-labeled glutamate, glutamine, and acetate.

Heavy drinkers had approximately 2-fold more brain acetate relative to blood and twice as much labeled glutamate and glutamine. The results show that acetate transport and oxidation are faster in heavy drinkers compared with that in light drinkers. Our finding suggests that a new therapeutic approach to supply acetate during alcohol detoxification may be beneficial.’

J Clin Invest. doi:10.1172/JCI65153.

Published March 8, 2013

Full article on The Journal of Clinical Investigation website, click here

For homepage of Graeme mason, lead rsearcher , click here

For the main Yale website, click here

Targeting young addicts

Article about how authorities in southern California are aiming to crack down on heroin addiction amongst young addicts

‘A heroin addict for years, Taylor Beatty is 22 years old, has been sober for a month, and says she faces a daily struggle against the drug that is addicting an increasing number of young people.

“I started using at 12 and this has been the biggest struggle I’ve had to go through in my life,” she said.

Taylor has been homeless for several years trying to regain her family’s trust. She recently overdoses and said she didn’t think she was going to make it. Luckily, she did.

Now, she’s in her 17th treatment center.’

Full Story – NBC

Rise in Prescription Drug Addiction

‘Can you name the leading cause of accidental death in the United States now?


It is prescription drug overdose.  Since 2009 death from legally prescribed narcotics has led auto accident deaths as the number one cause of accidental death in the United States.  More than 15000 die now annually.


How can we explain and try to understand the rise in legal narcotic misuse and addiction?


The answer: Not easily.  I believe that the problem has complex roots, including the failure to perceive correctly the breadth of the problem or the sources of the drugs.


For instance, if you were to ask someone to describe what comes to mind when they think of a drug addict, most likely the answer would be a picture of an individual in a crack house who is nodding out on cocaine or heroin; the picture is a myth.


The fact is that deaths due to legal pain medication far outstrip the number of deaths due to illegal drugs.’


Full Article – Kevinmed

Reality of Addiction

Very moving story by mom of an Ontario 21-year-old who accidentally  overdosed on fentanyl, having struggled with addiction for a long time.

‘After struggling with addiction and mental health issues for years, Lockie accidentally overdosed on fentanyl, a prescription opioid painkiller vastly more powerful than morphine.

“In the end I think he just didn’t realize that addiction was bigger than he was,” said his mother, Monica Lockie. “He was superintelligent and really felt that he knew more about the drug and was able to navigate his way around it. He didn’t really think that drugs would ever beat him.”

Full story – Metronews Canada

Science of addiction

Can’t vouch for the scientific accuracy of this, but a very well thought out and presented article on the science of addiction, showing in very simplistic terms and diagrams some of the main beliefs about addiction and how it works in the human brain.

Dr Urban D’Souza, School of Medicine, University Malaysia Sabah

“You are unable to stop when you want to, despite being aware of the adverse consequences. It permeates your life; you spend more time satisfying – Dr Nora Volkow

Addiction is the repeated or continued use of any mood altering drug/substance or also a behaviour that involves adverse dependence. It may be due to neurological problems or may be neurological impairment leading to such behaviour. Addiction may include nicotine, alcohol, drugs, exercise, sex, gambling or also internet usage!”

Full story – DaijiWorld

Drug Addiction – Harm Reduction or Abstinence ?

Interesting article concerning the approach by British Columbia to dealing with its problem of drug addiction.

Basically a contrast between the different merits of various harm reduction techniques employed, against a complete absence of all drugs.

Although this article focuses on the attitude of British Columbia, Canada – it is a debate that is highly applicable to everywhere that is trying to grapple with this problem.

”In other words, why are the taxpayer-funded authorities so focused on harm-reduction methods (including providing free needles, crack kits and hash pipes) that they reject funding for abstinence-based recovery programs, denying addicts a scientifically-supported treatment option?

I’m not the only one asking this. Abbotsford-Mission MLA Randy Hawes, whose son beat his drug habit through an abstinence-based program, says it was one of the issues that frustrated him and other Liberal MLAs who last fall questioned the authorities about it, through the health minister’s office.”

Full Story : The Province

Conflict and Confrontation

The very words conflict and confrontation often make people immediately wary, and many people will immediately back off any situation that could give rise to either of these two possibilities.

This is true to an extent even in an alcoholic home, which is likely to have experienced extreme examples of conflict and confrontation quite possibly for a very long time.

When an alcoholic enters a rehab/treatment center it is quite likely that the dynamic of the family home has become extremely bitter and twisted.

There are likely to be many reasons for this that can take quite a long time to unpick.

A rehab that is really focused on the long term good of the family will realise that an initial period of separation by the alcoholic and the family can give both parties a space that is desperately needed.

It is also part of the job of a rehab to prepare both parties to move forward again after the alcoholic has left a rehab/treatment center.

This is a bit of a generalisation based on the assumption that an alcoholic is living at home with a family.

This is not always true but is a fair enough model for people to draw distinctions from.

A rehab will certainly work on the basis that whoever has been in an alcoholic’s life with them prior to admission to a rehab/treatment center will have been in a serious amount of conflict with them.

The nature of conflict and confrontation in an alcoholic home is not normally a healthy one.

Conflict and confrontation can be extremely healthy, when approached by people who are genuinely trying to resolve difficult situations.

A rehab/treatment center will be a place where an alcoholic is admitted to largely because their own life has at some level broken down so much or become so unmanageable that they cannot carry on on their own.

Part of the process of that unmanageability will have been a very unhealthy relationship with most of the people, which may not be many in number, left in the life of an alcoholic at that point.

A rehab/treatment center will in some sense be a safe place physically, and emotionally, where the different parties can begin to get some distance from each other and hopefully see some of the distortions behind their thinking that have generated much of this ununmanageability.

Part of this conflict and confrontation will be what is known simply as the blame game.

The nature of blame is quite a complicated one, suffice to say that an alcoholic is likely to blame pretty much everyone for what is going on in his or her life, and the family is likely to blame the alcoholic for the problems in their lives.

Whilst some of this may be true, it is unlikely all to be true. Whilst in a rehab, the alcoholic will have time to begin to own some of this anger and blame, and dump it in the rehab, either on staff or in some type of group therapy.

This is actually an important function of a rehab, and should be encouraged.

There is always a danger that long-term, an alcoholic will simply carry on trying to blame other people for their lives.

That is out of the control of a rehab and its environment, and is more to do with the long-term mental health of the alcoholic themselves.

Part of the job of a rehab is to open up a sense of awareness of alcoholism and how it affects people.

It is quite likely that a rehab will want in patients to attend meetings of Alcoholics Anonymous or Narcotics Anonymous, and their awareness of the illness will be deepened by such attendance.

Yes but ….

The phrase yes but, may seem a fairly innocuous phrase, however in the context of alcoholism and recovery it can often be a very telling phrase, as it often indicates a particular attitude or in some cases obstinacy about the acceptance of a situation or a person that the other person does not want to accept.

It is important to note that this is somewhat of a generalisation, and the phrase yes but can be a very innocent one as well. It is the sort of phrase that is likely to be picked up by a councillor in a rehab/treatment center and used as an example of an alcoholic or their families refusal to accept reality.

A rehab/treatment center has a very short period of time relatively, to try and get through to an alcoholic and or their family, the nature of their alcoholism and what they are dealing with.

An alcoholic will have developed a significant number of coping mechanisms, all of which will be on display once they had entered a rehab/treatment center.

Often a counsellor in a rehab will see part of their job responsibility as being to try and break down some of these barriers of denial and make the alcoholic or their family understand the reality of what they are dealing with.

A rehab/treatment center will focus often quite intensely on breaking down barriers, hopefully in a safe and secure way an environment.

The phrase yes but, is often a bit of a ploy to deflect the fact that you disagree with someone in terms of what they are saying.

A rehab/treatment center will offer a number of therapeutic approaches to try and put in context the emotional unmanageability that an alcoholic is likely to be swimming around in.

The approach of the majority of staff in a rehab will be a mix of good cop bad cop.

That may not be a deliberate ploy, but there will be a recognition that once in a rehab an alcoholic has a short period of time to defuse the emotional timebomb that they have become.

Once a person has left a rehab, it is entirely up to them what they decide to do about their recovery.

No one can second-guess that, but a rehab will take the view that the time spent in a rehab should be a time when the alcoholic is primed about the nature of the illness and what recovery is.

A rehab/treatment center will take varying views about what level of persuasion or coercion they should put on the alcoholic or their family, but they will inevitably try and take an approach that generates some sense of awareness and understanding once the person is in a rehab.

What are symptoms of alcoholism?

When a person is admitted to a rehab, one of the first things that they and their family will be told, both directly and indirectly is that alcoholism is an illness, and that an alcoholic as such, is a person who is suffering from that illness.

Some people and literature refer to alcoholism as a disease rather than an illness, however the early members of Alcoholics Anonymous have always referred to it as an illness.

There are differences, medically, between the concept of an illness and a disease, and important though they are they are not really relevant to this issue.

The nature of alcoholism as an illness has been important for a number of reasons, not least of all as an attempt to try and remove some of the stigma surrounding the person being an alcoholic.

This in part is because the nature of alcoholism is often very public, both in terms of actual drunkenness, but also in terms of other behaviours when drunk and sober.

The premise behind alcoholism being an illness is that the alcoholic is effectively a sick person as opposed to a bad person.

This may be somewhat of a mute distinction, but is an important one nevertheless.

The question of alcoholism being an illness or not has to an extent died down, but from the point of view of the alcoholic and the family it is still a very important issue.

Part of the reason for this is a need both by the alcoholic and their family to be able to make sense of the alcoholics drinking and the chaos that ensues from it.

One of the questions that inevitably arises once someone is in a rehab is a questioning of why nothing was done about the person’s drinking beforehand.

A rehab will inevitably be a focal point for what the illness is, what it means and what symptoms if any are displayed by the alcoholic.

Most illnesses/diseases in a traditional medical model are likely to have symptoms that can be picked up on either by a doctor or other health professional. Alcoholism is not necessarily like that.

It is certainly true to say that if someone is an alcoholic they will reach a point where their drinking is out of control. An alcoholic is likely to have alcoholic blackouts at some point in the drinking, but this is not true of all alcoholics.

There is also quite a fine line between a heavy drinker and an alcoholic. As such, there is no way to define or classify an alcoholic based on the reality of what their drinking is.

A rehab/treatment center will be a safe place where someone can begin the process of recovery, and it is through the nature of the recovery that they will realise they were ill in the first place.

One of the dangers of trying to categorise alcoholics, is that to some extent people’s patterns of drinking will vary hugely, and there is no standard diagnosis that anyone could apply that would make any sense in terms of being able to spot an alcoholic.

This may be of little or no comfort to the family of an alcoholic, but in truth anyone who lives with an alcoholic at any level of intimacy is likely to get sucked into their illness, and lose much of their own life emotionally.

Accepting Sobriety

Sobriety can bring with it and normally does many new and different problems that both the alcoholic and their families are probably not expecting.

There is normally an expectation prior to admission to a rehab and getting sober, that once sober there will be a sort of happy families situation that the alcoholic and their family will immediately revert to.

This is not normally based on any type of reality, simply a belief that once the horror of active alcoholism has stopped, things must inevitably get better.

Unfortunately this is rarely true. Even though a person may have been admitted to a rehab, what happens afterwards can vary hugely both in terms of whether the person stays sober, stays sober and goes to Alcoholics Anonymous, stays sober and does not go to AA.

The person may drink again, either after a stint in rehab or several, or may stay sober and become what is known as a dry drunk.

Whatever the reality of what the alcoholic does it will present huge challenges both for them and for their family.

The family, assuming it is a partner and kids, will have huge expectations of what sobriety will bring, assuming it will become much more pleasantville.

This expectation is in large part the legacy of a coping mechanism that they will have developed over the years, as a way of getting them through the horrors of active alcoholism.

The reality of an alcoholic when sober can be very different. Long-term, things can work out and often do, but short-term a long period of readjustment after someone has been in a rehab will be necessary.

A rehab/treatment center should have its own family program, and should do much to help the family prepare for and adjust to life once an alcoholic has got sober and has left rehab.

This approach to discharge should happen pretty much from admission to a rehab. A rehab is somewhat of a bubble, and this in part is intentional.

It can provide a safe place where someone can detoxify if necessary, get sober and begin the process of rebuilding their life, understanding some of the emotional drives behind their drinking.

Accepting that a person is sober brings very real challenges both for the alcoholic and for their partner/family.

The nature of the challenges all be very different for both sides, what really matters is that both sides recognise that it will be a new and different relationship from before.

In one sense it will be a better relationship because it hopefully will be more real, but that does not mean that it will necessarily be an easier relationship in the short term.

If both sides recognise the necessity to rebuild the relationship once sober, then it can certainly be done with a lot of work on both sites.

Part of the job of a rehab is to prepare the family for life after rehab.

When an alcoholic is admitted to a rehab there is normally a huge sense of relief by the family that things are going to get sorted and better.

There is also a period of trepidation when the alcoholic is due to leave rehab, as to what is going to happen afterwards.

Both these feelings are very natural and understandable, and a rehab should be fully prepared to work with the alcoholic and the family to begin to process the emotions involved in both the stages of treatment.

Accepting Pain

The term acceptance and the term pain are not always necessarily linked, but have a fundamental connection with alcoholism, both active and in recovery.

Acceptance is a word that is bandied about a lot by people, as being a precondition of being able to move forward at any level with any problem.

It has become a bit of a cliché to say that someone needs to acknowledge they have a problem before they can do anything about it.

This attitude stems pretty much from step one of the Alcoholics Anonymous program, which will be the main focus of many people in a rehab, that the alcoholic needs to accept that they are powerless over alcohol – that their lives have become unmanageable.

In many ways the question is not why do people need to accept this reality, it is why do so many alcoholics not accept the reality of their drinking and active alcoholism, even after admission to a rehab/treatment center.

The pain of active alcoholism both to the alcoholic themselves and to their families or partners is overwhelmingly evident to everyone involved.

Indeed it is the nature of this pain that will eventually lead to some type of admission to a rehab/treatment center and subsequently onto Alcoholics Anonymous.

The question that is often asked, either in a rehab or before admission, is why does an alcoholic carry on drinking if they can see what it is doing to them.

There is no easy answer to this question, except to realise that an alcoholic’s denial of the drinking is in effect a protective mechanism.

Denial of any problem is to some extent protective, to an alcoholic it is the only mechanism they have of keeping the one thing they value more than any other safe, alcohol.

Admission to a rehab/treatment center may well be seen by an alcoholic as an admission of failure or as a real threat to their survival, it is much less likely that it will be a real acceptance of their own alcoholism.

Acceptance of someone’s alcoholism takes a long time and is often a long drawnout process. Perhaps the real benefit of being in a rehab/treatment center is that the alcoholic will spend a period of time with other people who have similar problems to their own.

This will inevitably help break down some of the barriers of isolation the alcoholic has built up to protect themselves.

An alcoholic will spend time with these people based in a rehab itself, and at meetings of Alcoholics Anonymous that we have is likely to bus people out to, or Alcoholics Anonymous meetings that take place at the rehab itself.

As a general approach to the concept of acceptance, it is worth stating that acceptance should be seen as a freedom not as a trap. The word acceptance is often portrayed as a concept of surrender a sort of do or die approach.

This attitude can be quite debilitating in many ways.

Acknowledging the reality of the situation by way of accepting it allows the person a number of real choices about how to move forward that they would otherwise not have. If a rehab can get a person to see this, and see acceptance of their alcoholism as being a real freedom, then the rehab will have done a good job.

Is Being Sober the Answer?

This may seem a strange question, as many people, seeing the destructive nature of someone’s drinking will do everything they can to try and get the alcoholic to stop.

This can include trying to get them into a rehab either through their own deliberations or possibly through some type of professional intervention.

These people, well-meaning or not, will most likely be of the view that they see the problem as being the drinking that the alcoholic demonstrates, and that that is the problem.

The obvious solution therefore is to get the alcoholic sober, by means of going into a rehab/treatment center or any other means open to them.

Whilst this may seem perfectly logical, the reality is that for many alcoholics alcohol is the solution to their problem, not the problem itself. Once sober, whether in a rehab or through Alcoholics Anonymous directly, the alcoholic may in some ways and many ways get worse.

This is simply because they are living with themselves without the anaesthetic of alcohol to dampen and take away the emotional pain or trauma that has been fuelling their drinking for probably many years.

Upon entry to a rehab/treatment center there will be quite a large degree of expectation from a number of people about what is going to happen.

The family or partner of an alcoholic will expect a rehab/treatment center to sober the alcoholic up and get them better.

The family or partner will have probably experienced a significant amount of abuse, possibly physical violence from the alcoholic when drunk or sober.

Any professional working in a rehab treatment center will be well aware that once the alcoholic gets sober there is likely to be a torrent of emotion that rises to the surface.

This may not happen immediately in a rehab, and will quite often happen once a person has left rehab and is back in so-called normal life.

In many ways it is this realisation that an alcoholic has to live with themselves in order to stay sober that will fuel their willingness to change or not.

This sense of beginning to realise their own emotional unmanageability may come very early on while in a rehab, or later once they have left.

What it really means is that there needs to be some management of expectation amongst the family of the alcoholic when admitted into a rehab.

It’s likely that the family has an expectation that a rehab will get a person sober and things will get better from then on. In one sense that will be true if the alcoholic stays sober, in that the drinking chaos will stop.

However if the alcoholic decides they do not want to change, either consciously or subconsciously, then their behaviour and their attitudes will get worse.

There are many stories within Alcoholics Anonymous of wives and husbands of alcoholics, who having stopped drinking for a while on their own prior to any type of treatment/rehab/AA meeting, where the wife or husband has pleaded with the alcoholic to start drinking again because their behaviour has become so horrific.

Sobriety is a precondition of being able to rebuild one’s life if one is an alcoholic. A rehab/treatment center can have a limited effect after the alcoholic has got sober.

Detoxifying an alcoholic if necessary, giving them a space where they can begin to be themselves, giving them some type of therapeutic intervention, taking them to AA meetings physically – these are the practical things that a rehab can do, and potentially sow the seeds of recovery.

Beyond that it is down to the alcoholic themselves as to how willing they are to own their own lives and change accordingly.