I got clean on December 4, 1984. I’ve spent close to forty years since then helping other people get clean and helping people get through trauma. I’ve seen a lot of good people come through treatment. I’ve also seen too many of them go back out.
Here’s what bothers me. In my experience, only about 10 to 15 percent of people who go through treatment get well and stay well over the long run. That number should make all of us stop and ask what we’re doing wrong.
I think part of the answer is simple. We still treat depression, anxiety, and addiction as if they live only in the mind. So we talk. We do groups. We work the Steps. I believe in all of that, and the Steps saved my life. But the brain lives inside a body. When something in that body is off, you can’t talk your way out of it.
Here’s what I see missed the most.
Sleep
Almost every addict I’ve worked with has trouble sleeping. Most programs call it withdrawal and give the person something to knock them out. Nobody asks whether that person can breathe at night.
Many of them have sleep apnea and have never been tested. Their breathing stops again and again while they sleep. They wake up worn out, foggy, and short-tempered. And this is the part families need to hear. When apnea goes untreated, depression can stop responding to treatment. The antidepressant doesn’t work. The vitamins and nutrients don’t work. So the dose goes up, then down, then another drug gets added. The real problem is still sitting there every night.
I had a client whose depression wouldn’t budge. I sent them for a sleep test, and it was apnea. Once they started using a CPAP machine, the depression got much better in a couple of weeks.
If the person you love snores loudly, gasps or chokes in their sleep, or is tired all day after a full night in bed, ask about a sleep study.
Hormones
When we checked at my treatment center, 85 percent of the people walking in the door were low in testosterone. That alone can cause depression and anxiety. The man looks tired, flat, cranky, with no drive. We call it depression and hand him a prescription. A lot of men are embarrassed and will never mention it. Someone needs to ask them straight out. Women should be checked too.
The thyroid belongs in the same conversation. A slow thyroid can look a lot like depression. An overactive one can look like anxiety or panic. One number isn’t enough. Ask for the full thyroid panel.
Blood sugar
Most of the alcoholics I’ve treated have had hypoglycemia, which means low blood sugar. The body treats alcohol a lot like sugar, so a drinker spends years going up and crashing down. When they quit, the body still wants that sugar. When it drops, they get shaky, anxious, angry, and low. Hypoglycemia can bring on depression and anxiety, and a crash can feel just like a craving. Eating on a regular schedule, with protein at each meal, and a lot less sugar and white flour, can help.
The gut
Your gut and your brain are in touch all day long. One of the main lines between them is the vagus nerve. When the gut is in bad shape, the brain feels it.
Years of drinking wear down the gut lining. Leaky gut can drive depression and anxiety. So can H. pylori, a stomach bacteria plenty of people carry without knowing it. H. pylori can also keep the body from absorbing B12 and iron. There’s a simple test for it, and it can be treated.
Iron
That brings me to iron. Low iron can feed anxiety and depression. It can leave a person drained and foggy, and it’s one of the big causes of restless legs that keep them up at night. Your brain uses iron to produce dopamine and serotonin. Ask for ferritin plus a full iron panel. Drinking heavily can push ferritin higher than it really is, so the doctor should look at the whole panel, not one number. And don’t start iron pills on your own. Too much iron is hard on the liver.
Head injuries
Ask about every hit to the head. Car accidents, fights, sports, falls, and blasts for anyone who served. As a police chaplain and someone who works with veterans, I meet a lot of people who got their bell rung and never told a soul. A brain injury can pass for depression, a bad temper, or a person who just isn’t trying. If nobody screens for it, it never gets treated.
Genes and the basics
Some people are born with a low level of feeling good. As a member of Dr. Kenneth Blum’s research team, I’ve seen how his work on Reward Deficiency Syndrome explains this. Those people go looking for something to fill that gap. When they understand that, a lot of the shame goes away.
Then there are the basics: a good diet, exercise, and spirituality. By spirituality I don’t necessarily mean religion. I mean whatever works for that person. All of it matters.
Recovery works best when we look at the whole person rather than focusing on one symptom at a time. Our guide to holistic approaches to alcohol addiction recovery explores how physical well-being, emotional health, nutrition, and ongoing support can fit into a broader recovery plan.
What to ask the doctor
I’m not your doctor, and this isn’t medical advice. But you have every right to ask for tests. Here’s where I’d start:
- A sleep study, before anybody prescribes one more sleeping pill
- Testosterone, total and free, for men and women
- The full thyroid panel
- Blood sugar, at least a fasting glucose and an A1C
- Ferritin and a full iron panel
- H. pylori and other gut testing
- A screening for past head injuries
Then make sure somebody turns those results into a plan. A lab report sitting in a file doesn’t help anyone.
After treatment
The hardest stretch often starts the day treatment ends. That’s one reason I serve as clinical content advisor for Wingman for Recovery, developed by Hayes Thomas. It’s an AI recovery companion that’s there 24 hours a day, 7 days a week, after a person leaves treatment. It helps them set goals, gives them someone to talk to at any hour, tracks their wellness, and brings the family in. It’s HIPAA compliant.
Technology can be one part of a continuing support system, but it doesn’t replace appropriate clinical care. For people who need additional help beyond a treatment program, online addiction therapy programs offer another avenue to explore ongoing professional support.
Stop blaming the person
Here’s what I want every family to understand. When we miss these root causes, people relapse. Then we turn around and blame them. We say they didn’t try hard enough. We say they didn’t really want it. A lot of them wanted it more than anything. They were fighting with one hand tied behind their back, and nobody looked.
If someone you love keeps falling down, don’t give up on them. Take this list to the doctor and ask.
About the Author
John J. Giordano, DHL, MAC, CAP, CCJS, is an EMDR specialist and serves as police chaplain for the North Miami Police Department. As a traumatologist, he works with officers after police shootings and with veterans living with PTSD. Clean since December 4, 1984, he has more than 41 years in recovery and nearly four decades treating addiction and trauma, and he has contributed to more than 80 peer-reviewed publications. He is Founder and Clinical Director of Root Cause Wellness. Learn more about him and what he does at johnjgiordano.com.
