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Cortisol Management Important in Alcohol Relapse Prevention

Posted in Alcoholism Treatment

Relapse sabotages successful recovery for many alcoholics and is considered a usual and predictable part of the disorder for many. Some, however, struggle with multiple relapses throughout their lives despite concerted efforts to recover from chronic, severe and even life-endangering alcohol-induced consequences. Some do not sustain significant periods of abstinence even after repeated attempts, multiple treatments and, by all appearances, doing the ‘right thing’. Several recovery clichés are usually referenced to account for those ‘frequent flyers’ that are in an out of treatment facilities, 12 Step programs and recovery.

Traditionally, the alcoholic is considered to have done something wrong, failed to do enough or to have remained in some form of denial. While these pathways to relapse are certainly at play for many who could circumvent relapse with a solid recovery program, some ‘fail’ despite one.

Addiction programs consistently address the potential for relapse as a substantial phase of treatment. The development of a detailed relapse prevention plan is commonly encouraged to increase the odds of remaining sober and to prepare for the ‘slippery slopes’ of abstinence. Relapse is typically considered to be a process that builds from identifiable and manageable warning signs into a powerful force of obsession and compulsion if unattended. Multiple signs and symptoms of alcohol relapse are commonly cited in such plans and typically include thought patterns, emotions and behaviors that signal the relapse process has begun and/or is escalating. Along with the signs and symptoms of a relapse process, prevention plans also commonly address ‘crisis’ or ‘emergency plans’ designed to help the recovering alcoholic cope during times of increased stress when they are particularly vulnerable to relapse.

Addictions treatment has traditionally focused upon habitual behaviors and the relapse potential of continuing involvement with the life circumstances of active use– ‘old people, places and things’. These ‘old’ lifestyle factors have generally been believed to contribute significantly to relapse due to triggered alcoholic thinking. Research in alcohol relapse, however, now suggests that the biochemistry of stress may play a far more pervasive, ongoing and biologically based role in relapse than previously thought. A recent study in the UK has found that actively drinking alcoholics, as well as those who are abstinent, tend to have higher levels of the human stress hormone cortisol than people who have never had the disorder. This finding may contribute to a significant shift in treatment options for alcoholism.

In the study conducted by Dr. Abi Rose at England’s University of Liverpool, high levels of cortisol were found to significantly increase the risk of relapse in alcoholism. Elevated cortisol levels in alcoholics are said to occur during use and to continue throughout withdrawal and even into prolonged periods of abstinence creating a long-term biochemical risk of relapse. Further, the high cortisol levels found in the brains of alcoholics create a persistent and strong biological vulnerability to relapse that may not be completely mitigated by behavioral changes. These findings may explain in part the ‘multiple treatment failures’ of those who have tried unsuccessfully and repeatedly to achieve sobriety. They may also offer hope that a successful path to recovery for these alcoholics will be found if medications can be developed to control the effects of high cortisol levels.

Dr. Rose cites the cognitive difficulties many alcoholics have that prevent their successful engagement in treatment programs and believes that abnormal cortisol levels may be the cause. High levels of the stress hormone have been found to impair learning, memory, decision-making, attention and the regulation of emotion—all usual ‘alcoholic symptoms’ and debilitating factors in the pursuit of treatment and sobriety. Medications that alleviate the negative effects of cortisol in the brains of alcoholics may improve treatment participation and treatment plan compliance while reducing the biochemical vulnerability to relapse. Such medications may help many that other treatment strategies have not.