Health
Overlooked Reasons Why People Relapse Despite Doing Everything Right
by John J. Giordano, DHL, MAC, CAP, CCJS
I’ve watched it happen for thirty-nine years. A man comes into treatment and does everything we ask. He goes to every group. He works the Steps. He calls his sponsor. Ninety days later he’s drinking again, and everybody says the same thing. He wasn’t ready. He didn’t want it bad enough.
I’ve been clean for more than forty years, and the Twelve Steps saved my life. I believe in therapy, groups, and the Steps. But I’ve stopped believing that relapse is always about willpower. Too often, something was wrong in that person’s body, and nobody ever looked.
People like to say 40 to 60 percent of people relapse. In my experience, the number who get well and stay well for at least a year is more like 10 to 15 percent. That should bother all of us. Here are the questions I wish every family would ask, starting with the one we miss the most.
The first question: did anybody ask about his sleep?
If I could get every detox and treatment center in the country to change one thing, this would be it.
Almost everybody who comes into detox can’t sleep. They toss all night, they’re up at three in the morning, and they’re begging for something to help. So what do we do? We throw medication at them to sleep. Nobody stops to ask why they can’t sleep.
A lot of them have sleep apnea. They stop breathing over and over all night long. The brain gets starved for oxygen, the body jolts awake, and they never get real rest. Alcohol and opioids relax the throat and slow the breathing, so years of using have made it worse. And nobody ever tested them for it.
Here’s the problem. Sleeping pills don’t help sleep apnea. They make it worse. Sedatives relax the throat even more and slow the breathing even more. So the person gets knocked out, but the sleep is worse than before. They wake up exhausted and foggy, and they’re told they’re just going through withdrawal.
Then they go on to treatment, still not getting quality sleep. They have cravings. They can’t pay attention in group, because they’re exhausted. They want to leave treatment. They’re irritable and depressed, so they get medication for that. It doesn’t work, because untreated sleep apnea makes them treatment-resistant. The depression and anxiety don’t lift, and the medication and nutrients don’t work the way they should. So they keep changing the pills. More milligrams, then less milligrams, then another medication on top of it. Now their brain is in a fog. They’re lethargic, and they’re not paying attention to anything. Round and round it goes. And when they relapse, we say they didn’t want it bad enough.
I sent one client for a sleep test. It was sleep apnea. They started wearing a CPAP mask, and within a couple of weeks their depression and a lot of their other symptoms eased dramatically. That’s what happens when you find the real problem instead of covering it up.
Does your loved one snore? Wake up gasping or choking? Stop breathing while they sleep? Are they tired all day no matter how long they were in bed? Ask the family, because they’re the ones who hear it. If the answers point that way, get a sleep study before anybody adds another sleeping pill. It’s one of the biggest things we miss, and one of the easiest to fix.
And sleep apnea is only one piece. When you add the other root causes to the mix, you have a recipe for failure.
Did anybody check his blood sugar?
In my experience, most alcoholics have hypoglycemia, low blood sugar. The body handles alcohol a lot like sugar, so the drinker rides a roller coaster, up when they drink and down hard after. When they stop drinking, the body still wants that sugar. That’s why there are donuts at the meetings.
A blood sugar crash makes people shaky, angry, anxious, and foggy, and it can feel a lot like a craving. Regular meals with protein and less sugar and white flour can take a lot of that edge off.
Did anybody look at his hormones?
At my treatment center, we found that 85 percent of the people coming in had low testosterone. Opioids and heavy drinking both drive it down. Low testosterone can cause depression and anxiety all by itself. The man comes in tired, flat, irritable, with no drive, and we call it depression. A lot of men are too embarrassed to bring it up, so somebody has to ask. Check it in women too.
The thyroid is the same story. A slow thyroid can look just like depression, and an overactive one can look like panic. Don’t settle for one number. Ask for the whole thyroid panel.
Did anybody ask about his gut?
The gut and the brain talk to each other all day long through the vagus nerve. Years of drinking damage the lining of the gut. H. pylori, a common stomach bacteria that a lot of people carry without knowing it, can get in the way of absorbing B12 and iron. H. pylori infection and leaky gut can cause depression and anxiety too. It’s a simple test, and it’s treatable.
Did anybody check his iron?
Low iron adds to anxiety. A big study out of Taiwan of almost 58,000 adults found that people with iron deficiency anemia were about one and a half times more likely to be diagnosed with anxiety, and more likely to have depression and sleep problems. The brain needs iron to make dopamine and serotonin. Low iron also leaves people exhausted and foggy, and it’s one of the big causes of restless legs, so they’re up all night. That’s a person who can’t focus in group.
It’s a simple blood test: ferritin and a full iron panel. Heavy drinking can make ferritin look higher than it really is, so have the doctor read the whole panel. Test first, then treat.
Did anybody ask about head injuries?
Car wrecks, fights, football, falls, and blasts if they served. I’m a chaplain for the North Miami Police Department and I work with veterans, and many of them have taken hits to the head and never told anyone. A brain injury can look like depression, anger, or just “not trying.” If nobody screens for it, nobody treats it.
Was he born running on empty?
I’ve been on Dr. Kenneth Blum’s research team for years. His work on Reward Deficiency Syndrome shows that some people are born low on dopamine, with a low baseline of feeling good. They go looking for something to fill the gap: alcohol, drugs, gambling, food, sex. When a man learns that, the shame starts to lift. But if we don’t fill that gap the healthy way, something else will.
Why it takes longer than 28 days
You can’t get somebody a sleep study, fix their blood sugar, and heal their gut in a couple of weeks. Treatment should be 60 to 90 days inpatient or residential, with outpatient after that. The 28-day model we’ve used for 70 years was built around alcoholism, and it doesn’t work very well. We still use it because the insurance company decides how long somebody stays, not the doctor and not the counselor.
What families can do
If someone you love is in treatment or just got out, you have the right to ask for these tests. Start with a sleep study, especially before anyone adds another sleeping pill. Then blood sugar, iron, testosterone, the whole thyroid panel, and gut testing. Ask the doctor, and ask the treatment center why they aren’t doing them. Then make sure somebody turns the results into a plan. A test result sitting in a chart doesn’t help anybody. When the body gets straightened out, the counseling finally has something to work with.
Get them moving, too. I’ve trained in martial arts for more than sixty years, and I’ll be eighty this year. Exercise is one of the cheapest, best things we have for mood.
I got clean at thirty-seven with three hundred dollars to my name. I was one of the lucky ones, and I don’t want the next person to have to be lucky. That means treating the whole person: the brain, the body, the history, and the spirit. Spirituality is the foundation of any recovery, not necessarily religion. Whatever works for that person. And it means we stop blaming people when we only looked at part of the problem.
Please check all this information out. It’s in the medical literature. That way you’ll really know what I’m saying is true, and then maybe we can do something about it.
About the Author
John J. Giordano, DHL, MAC, CAP, CCJS, has been in recovery for more than forty years and has worked in addiction and mental health treatment for thirty-nine. He is a Master Addiction Counselor, a Certified Addiction Professional, and a Certified Criminal Justice Specialist, a member of Dr. Kenneth Blum’s Reward Deficiency Syndrome research team, and chaplain to the North Miami Police Department. He is the author of four books, including The Kid From the South Bronx Who Never Gave Up. For more about him and his work, visit johnjgiordano.com.
