Alcoholism is a chronic disease. Like other chronic diseases, if left untreated, alcoholism can have serious, life-threatening consequences. Fortunately, there are effective treatment programs for alcoholism. While details vary from program to program, alcohol detox and alcohol rehab programs share certain essential components.
What Is Alcohol Detoxification?
Alcohol detox is an important preliminary step in the management of alcoholism. It is a medically supervised period of alcohol withdrawal. During this period, a doctor may administer medications to control symptoms, and the individual is monitored by health professionals to ensure his or her safety. In addition to medical care during withdrawal from alcohol, the person usually also receives education about his or her alcohol problem and its treatment.
Medical management of alcohol withdrawal for people who are alcohol dependent is often necessary, because the symptoms of withdrawal can be dangerous. They can include:
Not everyone has all these symptoms, and symptom can range from mild to severe. Typically, alcohol detoxification takes place in a regular medical ward of a hospital, a specialized detoxification unit, or in an outpatient clinic. Detox, which may last a few days to more than a week, is an important and necessary preparation for treatment.
What Are the Different Kinds of Alcohol Rehab Programs?
Alcohol rehabilitation takes place in a variety of settings:
Hospital- or medical-clinic-based programs. These programs offer both alcohol detox and alcohol rehab on an inpatient basis in specialized units. They are less common than they used to be, primarily because of changes in insurance.
Residential rehab programs. These programs can last from a month to more than a year and take place in a residential environment. Often, the treatment is divided into a series of stages that the person goes through. For instance, in the beginning, a patient's contact with others, including friends and family, is strictly limited. The idea is to separate the person from their usual social environment associated with drinking, and to develop a primary relationship with the other residents who are also recovering from alcoholism. Eventually, the person will be allowed more contact with people outside the residential community and may even go back to work or school, returning home to the treatment facility each day.
Partial hospitalization or day treatment. These programs provide four to eight hours of treatment a day at a hospital or clinic to people who live at home. They typically run for three months and work best for people with a supportive family and a stable, sober home environment.
Outpatient programs. These are run at hospitals, health clinics, community mental health clinics, counselor's offices, and residential facilities with outpatient clinics. Attendance requirements vary, and many of them are run in the evenings and on weekends to allow people to be able to continue working.
Intensive outpatient programs. These programs require nine to 20 hours of treatment per week and run for two months to one year. They work best for people who are motivated to participate and who have supportive families and friends.
What Happens in an Alcohol Rehab Program?
Alcohol rehab programs may be residential (a person lives on site during treatment) or outpatient. They all have these elements in common:
Initial assessment. When a person is first admitted to an alcohol rehab program, he or she receives a thorough clinical assessment. The assessment is then used to help determine the best approach to treatment. It is also used to help develop the treatment plan.
During the initial assessment, a counselor will ask questions about:
- The amount of alcohol a person drinks
- How long the person has been using alcohol
- Cultural issues around the use of alcohol
- The effect alcohol has had on the person's life
- Medical history
- Current medical problems or needs
- Medications being taken
- Mental health or behavioral issues
- Family and social issues and needs
- Legal and financial issues the person is confronting
- Educational background and needs
- Current living situation
- Home environment
- Employment history, stability, problems, and needs
- Previous experience with rehab or attempts to quit using alcohol
Typically, a psychiatrist or other medical doctor also will be part of the initial evaluation to assess any additional psychiatric and medical problems that may be present. If it's determined during the initial assessment that there are urgent medical issues that need to be treated or that the person needs a detox program, the person may be referred to a hospital or other medical facility until his/her condition is stable enough to begin rehab.
Development of a plan. Following the assessment and, if needed, a detox program or other medical care, the person will be assigned a counselor or case manager. Together, they will work out a detailed treatment plan that identifies problems, goals, and details about how to address the problems and reach the goals. That plan will be carried out by a team of trained individuals that can include a social worker, counselor, nurse, psychologist, psychiatrist, or other professional.
Group and individual counseling. Counseling is an integral part of the treatment for alcoholism. Counseling gives the individual in rehab tools to accomplish important goals:
- Overcome denial
- Recognize problems
- Become motivated to solve problems
- Address mental health issues such as depression or anxiety disorders
- Change behavior
- Re-establish healthy connections with family and friends
- Build new friendships with people who don't use alcohol
- Create a recovery lifestyle
Individual assignments. Throughout the rehabilitation process, the person will be given materials to read, listen to, and watch, will be asked to write about his or her experiences or responses to treatment, and given new behaviors to try.
Education about substance use disorders. Often, people who have a substance use disorder such as alcoholism are in a state of denial, believing their drinking is normal. In order to progress in recovery, they need to confront the fact that they do have a problem with alcohol and acknowledge the dangers that the problem present.
Life skills training. When someone who has been dependent on alcohol goes into recovery, he or she may need training in these areas: managing anger, stress, or frustration; employment skills; goal setting; spending leisure time; developing social and communication skills; and managing money and time.
Relapse prevention training. It's important that the person recovering from alcoholism learn to recognize situations that can trigger a relapse and how to avoid them.
Orientation to self-help groups. Most alcohol rehab programs require participants to join a self-help group after the program ends to help them continue on the path of recovery. Taking part in a self-help group is not considered part of treatment, but rather an essential part of maintenance.
Most people are familiar with 12-step programs like Alcoholics Anonymous, which has been highly successful at helping people stay sober. But there are people who don't like the 12-step approach for a variety of reasons, including its spiritual or religious overtones. So, most rehab programs include orientation to other programs such as SMART, which uses cognitive methods to help people stay sober, Women for Sobriety, which is a support program for women that focuses on issues that are specific to women in recovery, and Moderation Management, which is a program for people who want to moderate their drinking rather than stop. Moderation Management does recommend abstinence for people who aren't successful at moderation.
In addition to the above elements, many programs also include treatment for mental disorders.
Medications are also sometimes used to help a person stay sober, such as the drug disulfiram (Antabuse), which causes an immediate, unpleasant (though safe) reaction of nausea and flushing if the person drinks while taking it. Naltrexone (Vivitrol, ReVia) is also used, sometimes in combination with Antabuse or other medicines, to block the euphoria from drinking and reduce the craving for alcohol, particularly in people who binge drink. Acamprosate (Campral) is another medication used to curb the desire to drink, and the anticonvulsant drug topiramate (Topamax) also has been shown in early research studies to help reduce drinking urges and behaviors. The anticonvulsant gabapentin (Neurontin) also has been shown in preliminary research to help reduce anxiety symptoms associated with alcoholism, and the drug divalproex (Depakote) has been shown to reduce drinking behavior in people with both bipolar disorder and alcoholism. Antidepressant medicines can help treat depression in people who are in recovery from alcoholism, but they have not been shown directly to curb drinking behavior, and tend to be less effective for depression when someone is actively and regularly still drinking.
What Are Follow-up and Aftercare Programs?
Experts emphasize that it's important to consider someone who has had a problem with alcohol dependence and is now sober to always be in recovery -- no alcohol treatment program can guarantee a person will not relapse and begin drinking again.
To help prevent relapse, people who have gone through treatment for alcoholism will periodically meet with a counselor or a group. The purpose is to assess how well the person is managing and to offer help in dealing with the challenges of daily living without alcohol.
How to Choose an Alcohol Treatment Program
The federal government's Substance Abuse and Mental Health Services Administration (SAMHSA) has a list of 12 questions people should consider when selecting a treatment program:
- Does the program accept your insurance, and if not, will they work out an affordable payment plan?
- Is the program run by trained professionals who are state-accredited or licensed?
- Are psychiatrists directly involved in patient care, and how often does a doctor meet with a patient or resident? Is the facility clean, organized, and well-run?
- Does the program cover the full range of individual needs from medical through vocational and legal?
- Does the program address sexual orientation and disabilities and provide age, gender, and culturally appropriate treatment services?
- Is long-term aftercare encouraged, provided, and maintained?
- Is the treatment plan continuously assessed to ensure it meets changing needs?
- Are there strategies to engage and keep the individual in longer-term treatment, which increases the chance of success?
- Are there counseling and other behavioral therapies that enhance the ability to function in the family and community?
- Is medication, if appropriate, part of the treatment?
- Is there ongoing monitoring of possible relapse to help the person return to abstinence?
- Are there services or referrals offered to family members to ensure they understand the process and support the individual in recovery?