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Key messages about the management of relapse
Breakout session highlight, Anne Lingford-Hughes
I have a very simple summary, which is that relapse is common, and that is very important: we all know that but sometimes we are working within a framework of either how our services are commissioned, or what we are being asked to do – politely, or enforced to do – as a clinician, that people forget that relapse is part of the disorder.
I reminded people that McLellan and O’Brien, many years ago, saw alcoholism much like other disorders, such as asthma, hypertension and diabetes, where there are elements of environment, behaviour and attitude, which the patient may be able to modify and which they may need to modify, but there is a heritable component as well. If people are doing badly in diabetes, asthma or hypertension, we don’t tend to discharge them, whereas that is often exactly what happens to a person with an alcohol problem. I was just contrasting the difference, in that we need to relapse which is part of the disorder.
What should you do? There are no key predictors but various themes came up, such as sleep and depression – not necessarily depression reaching diagnosis, but a level of symptoms. The severity of dependence also came up as an issue, and I realised that that would have fed into some of the presentations that the others went to.
The bottom line, however, in terms of trying to do the right treatment – this was a statement in a summary from Project MATCH, which was the largest treatment study ever done in the world – the idea was that if you matched certain characteristics of people with alcohol problems, you would somehow find the magical ‘right’ treatment. The bottom line was that as long as people were in treatment, they did well. This was a commentary: it doesn’t matter what you do, but do it well. That was really the summary, that actually you do something and you do it well, and patients will get better.
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