Over the years in private practice, I have begun to recognize certain patterns in the types of patients that tend to respond, or not respond, to the alcohol treatment options that are available. I have been seeing that patients who drink alcohol mainly for it’s anti-anxiety and after work/end of the day calming effect, tend to respond very well to drugs that exert their effect on the GABA receptors in the brain. Baclofen and Neurontin are two examples of these types of drugs that are available as alcohol treatment options. Alcohol’s effect on the GABA-A receptor is responsible for it’s anti-anxiety and calming effect. I haven seen these patients either stop drinking completely, or go back to controlled social drinking, just with medication alone.
However, patients that have something else going on besides, or in addition to, what I have described, tend to have a more difficult time with treatment for their addiction to alcohol. It can be more difficult for alcohol treatment options, such as medication (Baclofen, Neurontin, naltrexone, Topamax) and/or cognitive behavioral therapy, to be effective in treating their addiction.
For example, a patient with a significant other that wants to keep him or her in the sick role is going to have a hard time getting better. A patient who wants the secondary gain from their partner, by staying in the sick role, is another example. Also, it is imperative to stay away from triggers early in treatment in order to remain abstinent. If a patient is stuck in a bad marriage or relationship, the person he or she is involved with is frequently a big trigger for their drinking. Unless the relationship is ended, or improved with relationship therapy, that type of patient is going to have a very hard time remaining abstinent from alcohol. I tend to see these types of patients drop out of treatment. I recommend relationship therapy for these couples, but not everyone will follow through with my advice. I think that this refusal in itself is a sign of their shared pathology.
Patients with borderline personality disorder can have a hard time remaining abstinent. These patients have a lifelong enduring pattern of severe emotional lability and impulsive behavior. They have severe highs and lows in their mood and anxiety levels. These mood swings can occur and change throughout the day, or at various times throughout the week. This is different than bipolar disorder, where “highs and lows” stay constant for a more sustained period of time. This combination of intense mood lability, with poor impulse control, can make a well-intentioned person with this disorder be unable to abstain from alcohol.
Addiction treatment and alcohol treatment options should be individualized. Patients do share similarities, but they also display their own individual differences.