Matching Treatment with Cognitive Capacity

In order for treatment to have long-term benefit, the participant must be able to process the new information and integrate it with existing knowledge.  But the cognitive capabilities of the problem drinker are often markedly impaired during the early weeks of recovery.  (Unsophisticated observers may not fully appreciate the degree of impairment because verbal competence tends to be less affected than other faculties.)

Ironically, it is during these early weeks of sobriety that rehabilitative treatment is generally presented.  Treatment for problem drinkers tends to be of high intensity and short duration.  Not surprisingly, this treatment strategy is associated with high relapse rates.  

An alternative strategy, which stretches out the treatment dose, so involvement with treatment provider is less intrusive but lasts for a much longer duration runs counter to the desires of the alcohol abuser, loved ones, and the courts.  All want immediate gratification of their desire to be free of this problem, and each, for their own reasons, finds the prospect of short-term intensive treatment compelling. 

Relapse Prevention

The pathogenic effects of alcohol abuse on Brain are well established, and worthy of your attention. An appreciation of the functional and structural consequences may be helpful to individuals who retain access to a good rational processing system.

Nevertheless, the Problem of Immediate Gratification (the PIG) is so intrinsic to human motivation that it influences the strategy we select to get rid of it.   Intellectual appreciation is not sufficient to escape the corruptive trap of chemical dependency, and for the vast majority of problem drinkers detoxification and short-term treatment have little long-term impact. Preventing relapse requires change at a deep motivational level.