What is the Success Rate for Recoverying Alcoholics?

The scale and impact of alcohol addiction and dependence on individuals and society as a whole should not be underestimated. There are currently 586,780 dependent drinkers in the UK, with 82% not accessing treatment.

Further, in 2018 there were 7,551 alcohol-specific deaths and alcohol remains the biggest risk factor for death, ill-health, and disability among 15-49-year-olds. [1]

For those people who do seek treatment for their alcohol addiction, it is important to find out what their chances for success are, what factors influence the success rates, how well different forms of treatment work, and how to deal with it when people relapse (go back to drinking alcohol after they have completed treatment).

What do we mean by “success”?

First of all, we need to define what exactly we mean when we say that someone has recovered from alcohol dependence or addiction. It would be easy to measure success by counting how many days it has been since they last drank alcohol, but this does not capture the whole picture of what it means for someone to be in recovery from alcohol addiction.

Success can mean very different things to each individual who is going through the recovery process. Giving people the space to access treatment on their own terms and with their own measures of success is vital to making sure that they can succeed in a way that is meaningful to them. [2]

As well as being sober, recovery can include:

1. Health: Improving health and wellness and managing health conditions
2. Home: For many people, having a stable and safe place to live is an important marker of recovery
3. Purpose: Finding a sense of purpose, be that employment, hobbies, or independence
4. Community: Being accepted into a community, with friendships, relationships, and love

It is also important to remember that recovery isn’t binary. In other words, you are not just in a state of “not recovered” or a state of “recovered”. Recovery happens in stages, and each of those stages has its own challenges and approaches.

What is the success rate for recovering from alcohol dependence?

Although the majority of people with alcohol dependence are not seeking treatment, a significant percentage are. The UK government has tracked the immediate (not long-term) success rate of treatment for alcohol addiction.

The percentage of people who complete the treatment alcohol-free has remained stable for the last few years at 61%. [3]

In a 16-year prospective study (where people were followed for 16 years), some key findings about the success rate of alcohol recovery were found:

• People who do not seek help are less likely to go into remission (stop drinking alcohol)
• There was a 62% remission rate for people who did seek treatment (in line with what the UK government report)
• The relapse rate (going back to drinking alcohol after a period of not drinking it) was 60% for people who did not seek help
• The relapse rate was 40% for people who did seek help [4]

An important takeaway from this is the importance of seeking help. Receiving treatment for alcohol addiction increases the likelihood of stopping drinking and also reduces the chances of going back to drinking.

What influences the chances of recovery?

Every story of addiction is deeply personal and unique. The factors that can influence becoming dependent on alcohol in the first place, as well as the factors that can influence the likelihood of recovering, can vary widely between individuals.

1. Genetics

There is a genetic component to alcohol addiction. We know this from scientific studies that have used a few different approaches. For example, the risk of alcohol dependence in people who are adopted is more closely related to their birth parents’ risk than their adopted parents’ risk.

In twin studies, the risk of alcohol dependence in identical twins is higher than in non-identical twins (identical twins, of course, share more genes) [5]

A specific “alcohol gene” has not been identified, and the genetic risk for alcohol dependence is probably due to a complex interaction between different genes. What it can mean, however, is that people who are genetically predisposed to being dependent on alcohol could have a harder time when attempting recovery.

2. Mental health problems

Often, people with an alcohol dependence are also dealing with other mental health problems. Sometimes these can be a result of the alcohol dependence, but at other time an underlying mental health problem can make alcohol dependence more likely. The most common mental health issues that can influence alcohol dependence include:

• Antisocial personality disorder (ASPD)
• Bipolar
• Social phobia
• Panic disorder
• Post-traumatic stress disorder (PTSD)
• Schizophrenia
• Major depression (especially for women) [6]  [7]

For recovery to be a success, it is important to also receive treatment for any underlying mental health issues that could be contributing to the alcohol dependence. Not doing so will make long-term recovery more unlikely.

3. Family

Early life experiences and the nature of family interactions can make alcohol dependence more likely. For example, people who experienced more than two adverse events during their childhood have a higher risk of developing a dependence on alcohol over their lifetime [8]

In contrast, family relationships (as long as they are positive) can help make recovery a success. Including family in interventions to treat alcohol dependence can improve recovery rates [9].

This can include training family members in how to support the person with alcohol independence, involving family members directly in the person’s treatment, and treating individual issues that the family members may have.

4. Peer support

Many people who are in recovery from alcohol addiction struggle with the stigma and judgments that can come from other people. There is some evidence that placing people in recovery into community-based facilities with other people who are also in recovery can help to reduce the impact of this stigma and improve recovery rates.

5. Demographics

Some factors that make each individual different can also have an impact on the chances of successful recovery from alcohol dependence. For example, women, older people, people with a higher level of education, people with more social resources, and people who don’t use avoidance as a coping mechanism are more likely to successfully stop drinking [10]

How common is relapsing after successful treatment for alcohol dependence?

Unfortunately, relapsing after treatment for alcohol dependence is quite common. 40-60% of people relapse within one year. Relapsing is more common in the first year, but can also happen years after successful treatment [11].

Some factors can make relapse more likely, including:

• More severe alcohol-related problems
• More depression symptoms
• Lower belief in own ability to cope
• Poor coping skills
• Denial of the extent of the problem with alcohol [12]

What are the warning signs of a relapse?

There are some warning signs that indicate a relapse is becoming more likely. If intervention is initiated as soon as these warning signs appear, relapse can be prevented.

1. A change in attitude, including losing enthusiasm for continuing with treatment
2. Mood swings and rising stress levels. If alcohol is a coping mechanism for stress, rising stress levels could lead to the individual turning to alcohol to cope
3. Denial that the person’s attitude or behaviour is changing.
4. A return of withdrawal symptoms such as shaking
5. A change in routine, such as skipping meals and not sleeping properly
6. A loss of self-control, including making unhealthy decisions.
7. No longer engaging with support, such as family members and treatment support workers

Is relapsing normal in recovery?

If a relapse does occur, this is not the end of the recovery process. Relapsing is common and is not a reason to abandon recovery altogether. Each stage of the recovery process has its own risk factors for relapse, so relapses can happen even when the person has been in recovery for a decade.

As touched on above, relapse is a gradual process. A relapse does not occur only at the very moment a drink is raised to the lips. The relapse process will have started weeks or month before this point. [13]

Relapsing happens in three distinct stages:

1. Emotional relapse – bottling up emotions, isolating, focusing on others, and a lack of self-care (physical and emotional)
2. Mental relapse – craving, fantasising about the past, bargaining, looking for relapse opportunities
3. Physical relapse – drinking alcohol [13]

Prevention of relapse can happen at any point before the person drinks alcohol again, and preventing the relapse is easier in the early stages than it is right before the physical relapse occurs.

How to cope with relapses

A powerful factor in recovery is challenging negative thinking. Negative thinking can make recovery less likely and can make relapse more likely.

1. Fear

Fear is a common thinking pattern that can affect recovery from alcohol dependence quite dramatically. For example, the person in recovery may be afraid that they will fail and not successfully recover.

If they have relapsed in the past, this can feed into their fear of failure and make them less likely to want to continue. Therapy can help to challenge this negative thought pattern and encourage the person to face their fear of failure head-on [13].

2. Redefining fun

Many people in recovery look back to the time when they were dependent on alcohol as a period of their life that was fun. In comparison, recovery can seem boring and difficult.

Of course, since they are in treatment, it is likely that they are viewing their time in addiction in a skewed way. It is unlikely that it was as fun as they remember, and since they have sought treatment, it is likely that it was actually having a negative impact on their life.

One factor that can feed into this issue is expectancy. When someone expects an experience to be fun, they will be more likely to experience it as fun, and visa versa. It is important to help people in recovery redefine what they expect to be fun so that they aren’t drawn back to using alcohol out of boredom or as a way of adding fun back into their lives. [13]

Learning from setbacks

A setback can be defined as any behaviour that makes a relapse more likely. For many people in recovery, any setback can be seen as a complete failure and this can then set a vicious cycle in motion whereby they stop engaging with treatment because they have “already failed”.

Setbacks are not, in fact, failures. They are a normal part of the process of recovery and all they indicate is that there are areas where work still needs to be done. Being reminded of past successes and progress can help to reduce this type of catastrophic thinking. [13]

Can relapsing be dangerous?

A relapse can be one of the most dangerous moments in alcohol dependency. During active addiction, tolerance to alcohol gets higher. This means the body becomes better able to reduce the effects of alcohol, so more and more is needed to produce the same effect [15].

Once the person stops drinking alcohol and is in recovery, however, tolerance starts to return back to normal levels.

When someone returns to drinking alcohol after a period of abstinence, they may not be aware of how much their tolerance is reduced. They may instead drink as much alcohol as they would have at the height of their addiction, but with their tolerance much lower the level of alcohol will be too much for their body to cope with.

This can make overdosing on alcohol much more likely, as well as being involved in alcohol-related accidents, both of which can result in severe injury and even death.

What is Alcoholics Anonymous?

Alcoholics Anonymous (AA) is a faith-based programme that helps people with a dependence on alcohol to overcome their addiction. Its hallmarks include that it is anonymous, regular group meetings where participants are encouraged to share their feelings and experiences, and the inclusion of a 12 step programme.

There is no therapist at AA meetings and AA does not just focus on treating addiction. Instead, it encourages participants to learn a completely new way of living [16].

What are the 12 steps in AA?

The 12 steps of AA include the following:

1. Admitting to being powerless
2. Believing that a greater power can restore wellbeing
3. Making a decision to turn life over to God
4. Examining the self and seeing all moral wrongdoings
5. Admitting previous wrongs to God and to another person
6. Being ready to have God remove character defects
7. Asking God to remove shortcomings
8. Listing everyone the person has harmed and being willing to make amends to them
9. Attempting to make amends to everyone the person has wronged, except in cases where they would be harmed by contact
10. Continuing to examine the self and admitting to wrongs
11. Praying and meditating to improve contact with God
12. Carrying the message to other people dealing with alcohol dependence [17]

Does AA work?

A recent Cochrane Review has been carried out to examine how effective AA is, compared to other common treatments for alcohol dependence, such as cognitive behavioural therapy (CBT) and motivational enhancement therapy (MET).

A Cochrane Review is a gold standard for scientific evidence because it combines together the results from a large number of studies and experiments, which gives it a large amount of statistical power and reliability.

In this review, 27 studies were looked at, with a combined 10, 656 participants. They found that AA treatment had higher rates of sustained abstinence compared to CBT and MET (although other measures such as alcohol-related consequences and addiction severity were the same for all three treatments). An average of 22-37% remained sober after AA support, compared to 15-25% for the other two treatments [18].

The most likely explanation for why AA appears to be more effective than other treatments is the peer support that people have access to. As mentioned earlier, having support from peers who are also going through alcohol dependence treatment can improve chances of recovery. Peer support is at the heart of AA and it is likely that it is this that helps people to get sober, and remain sober.

A word of caution is necessary, however. It is important to remember that people sign themselves up to AA. It is possible that the sort of person who is willing to take that step is also more ready, or more willing, to engage with recovery. AA may appear to work because the people who sign up are exactly those that will be more likely to recover.

Final thoughts

Alcohol dependence is a complex and deeply personal issue. The road to recovery is never linear and there are often setbacks. We do, however, have plenty of evidence and knowledge about what can help someone succeed in their recovery and how to prevent them from relapsing (or how to cope with the relapse if it does happen).

Treatment can work and does work for many people, and the more we find out about the factors that can influence recovery and relapse rates, the more effective our treatment options will become.

References

[1] https://alcoholchange.org.uk/alcohol-facts/fact-sheets/alcohol-statistics
[2] https://www.samhsa.gov/homelessness-programs-resources/hpr-resources/defining-success-people-recovery
[3] https://www.gov.uk/government/publications/substance-misuse-treatment-for-adults-statistics-2017-to-2018/alcohol-and-drug-treatment-for-adults-statistics-summary-2017-to-2018
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1976118/
[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056340/
[6] https://pubmed.ncbi.nlm.nih.gov/10911586/
[7] https://pubs.niaaa.nih.gov/publications/arh26-2/90-98.htm
[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622772/
[9] https://www.tandfonline.com/doi/abs/10.1080/09595230500302356?src=recsys&journalCode=idar20
[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1976118/
[11] https://health.usnews.com/wellness/articles/2017-04-24/why-do-alcoholics-and-addicts-relapse-so-often
[12] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1976118/
[13] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553654/
[14] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553654/
[15] https://pubs.niaaa.nih.gov/publications/aa28.htm
[16] https://www.scientificamerican.com/article/does-alcoholics-anonymous-work/
[17] https://www.alcoholics-anonymous.org.uk/about-aa/the-12-steps-of-aa
[18] https://www.advisory.com/daily-briefing/2020/03/16/alcoholics-anonymous

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