You’ve acknowledged a problem, and you’re ready to seek help, but you’re trying to wrap your head around an important question: How does alcohol rehab work?
It’s understandable, given that much of drug and alcohol treatment isn’t as obvious as the health care you receive for a more traditional ailment. A sinus infection, for example, is pretty straightforward: You go to the doctor, you’re prescribed a dose of antibiotics and a week or so later, you’re better.
Drug and alcohol treatment, like many other approaches to psychological ailments, is a bit more complicated. While many individuals with a drinking problem who decide to get help want a quick fix, treatment is rarely that simple. However, the end results make for much more profound and meaningful life changes than simply the absence of a drinking problem.
So how does alcohol rehab work? Let’s take a look.
How Does Alcohol Rehab Work: What It Is
In answering the question of how does alcohol rehab work, it’s important to first know what it involves. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), “People often think there are only two places to get help for alcohol problems — Alcoholics Anonymous (AA) or residential rehab. But today there are more choices than you might expect. Healthcare professionals now provide up-to-date treatments backed by science. Care is offered at different levels of intensity in a variety of settings. Many outpatient options allow people to maintain their regular routines and their privacy, too, if desired.”
To understand the nature of what alcohol rehab entails, you need to first determine which type of care you’ll receive. And while there are a number of different treatment methods for alcoholism, it’s important to note, according to one case study for Princeton University, that “although a variety of treatment modalities have been described, it is important to note that alcoholics and alcohol abusers are rarely, if ever, treated with only one method … the important point is that, in practice, no single treatment is considered sufficient for treatment of alcoholism.”
So what are some standard models of treatment? According to the NIAAA and the American Society of Addiction Medicine, they can include four basic levels of care, many of which are used concurrently or consecutively with one another:
- “Outpatient. Regular office visits for counseling, medication support, or both. See below for some ‘lower intensity’ alternatives for outpatient care.
- “Intensive outpatient or partial hospitalization. Coordinated outpatient care for complex needs.
- “Residential. Low or high intensity programs in 24-hour treatment settings.
- “Intensive inpatient. Medically-directed 24-hour services; may manage withdrawal.”
But it’s important to keep in mind, especially with heavy alcohol use: None of these methods of treatment can truly be effective until an individual is first weaned off of alcohol, which means that if you’re wondering how does alcohol rehab work, it usually begins with a medical detox program, according to the National Institute on Drug Abuse (NIDA): “Detoxification, the process by which the body clears itself of drugs (or alcohol), is designed to manage the acute and potentially dangerous physiological effects of stopping drug (or alcohol) use. As stated previously, detoxification alone does not address the psychological, social, and behavioral problems associated with addiction and therefore does not typically produce lasting behavioral changes necessary for recovery. Detoxification should thus be followed by a formal assessment and referral” to treatment.
What Do Those Modalities Involve?
How does alcohol rehab work? Let’s start with the detox process. According to Harvard Health Publishing, a drinker’s brain and body become dependent on alcohol over time: “In a heavy, long-term drinker, the brain is almost continually exposed to the depressant effect of alcohol. Over time, the brain adjusts its own chemistry to compensate for the effect of the alcohol. It does this by producing naturally stimulating chemicals (such as serotonin or norepinephrine, which is a relative of adrenaline) in larger quantities than normal. If the alcohol is withdrawn suddenly, the brain is like an accelerated vehicle that has lost its brakes. Not surprisingly, most symptoms of withdrawal are symptoms that occur when the brain is overstimulated.”
Those symptoms can include “trembling (shakes), insomnia, anxiety, and other physical and mental symptoms” — including delirium tremens, also known as the DTs, in which “the brain is not able to smoothly readjust its chemistry after alcohol is stopped. This creates a state of temporary confusion and leads to dangerous changes in the way your brain regulates your circulation and breathing. The body's vital signs such as your heart rate or blood pressure can change dramatically or unpredictably, creating a risk of heart attack, stroke or death.” Needless to say, because of the several health risks associated with alcohol withdrawal, a medically safe, supervised detox setting is the best course of action for those at the outset of the alcoholism treatment process.
But what about the other levels of care? What do they provide? According to the American Society of Addiction Medicine (ASAM), they work as follows:
- Outpatient treatment: “This level of care typically consists of less than 9 hours of service/week for adults, or less than 6 hours a week for adolescents for recovery or motivational enhancement therapies and strategies.”
- Intensive outpatient “is an organized outpatient service that delivers treatment services during the day, before or after work or school, in the evening, and/or on weekends” that provides “services that are capable of meeting the complex needs of people with addiction and co-occurring conditions.”
- Residential treatment: Also known as residential inpatient, it provides around-the-clock services with a mandatory minimum of clinical and therapeutic hours, psychotherapeutic groups, lectures, one-on-one counseling and more. Patients live on campus and navigate the treatment process as part of a community of peers.
- Long-term residential treatment: Often, this level of care combines residential treatment with intensive outpatient, with clients remaining on campus over an extended period of time — sometimes up to 90 days — as part of a treatment community. As part of inpatient, they may live with the other patients of their particular treatment track; as part of outpatient, they may reside in a sober living facility on or associated with the treatment center. Either way, if you’re wondering how does alcohol rehab work, the effectiveness is dependent on the level of care you receive.
How Does Alcohol Rehab Work: What Happens In Each Level of Care?
If you’re asking, “How does alcohol rehab work?,” know this: Effective facilities recognize that there is no one-size-fits-all approach to alcoholism treatment, which means that not only does it differ from rehab, but also from patient to patient in each rehab. The more comprehensive the treatment, the better the chances at recovery, but as a whole, according to the National Institute of Health, “Treatment there is highly structured. It usually includes several different kinds of behavioral therapies.” What types? According to the NIDA, several are effective at treatment both alcoholism and addiction, including:
- Cognitive Behavioral Therapy (CBT), “based on the theory that in the development of maladaptive behavioral patterns like substance abuse, learning processes play a critical role. Individuals in CBT learn to identify and correct problematic behaviors by applying a range of different skills that can be used to stop drug abuse and to address a range of other problems that often co-occur with it.”
- One-on-one counseling, in which “the therapist provides … stimulating discussion about personal substance use and eliciting self-motivational statements. Motivational interviewing principles are used to strengthen motivation and build a plan for change. Coping strategies for high-risk situations are suggested and discussed with the patient.”
- Twelve Step Facilitation Therapy, “an active engagement strategy designed to increase the likelihood of a substance abuser becoming affiliated with and actively involved in 12-step self-help groups, thereby promoting abstinence.” (It’s worth noting that researchers, in a peer-reviewed 2013 paper in the journal Social Work in Public Health, found that “there is clear evidence from a variety of sources that early involvement, in the form of meeting attendance and engagement in recovery activities, is associated with better substance use and psychosocial outcomes as well as reduced health care costs.”)
- Family Therapy, in which “therapists seek to engage families in applying the behavioral strategies taught in sessions and in acquiring new skills to improve the home environment.”
- In addition, a number of other therapeutic modalities may be employed, from Cognitive Processing Therapy to Dialectical Behavior Therapy to Trauma Therapy. Some facilities with an on-campus fitness center may offer Fitness Therapy, and Activity Therapy often plays a role in facilitating trust, unity and the ability of patients to find enjoyment in activities unrelated to drinking.
Still, you may be wondering: “How does alcohol rehab work?” Effective treatment, using these methods, addresses the biological, emotional, mental and physical needs of those who have become addicted to alcohol. Because of the sweeping changes alcohol addiction makes to the body and mind, comprehensive treatment is necessary in severe cases to “reset” individuals. While they may seem like drastic measures, it’s worth noting two things:
One: Alcohol, left untreated, is a killer. According to the NIAAA, “An estimated 95,000 people (approximately 68,000 men and 27,000 women) die from alcohol-related causes annually, making alcohol the third-leading preventable cause of death in the United States.”
Two, according to the U.S. Surgeon General: “Treatment is effective. As with other chronic, relapsing medical conditions, treatment can manage the symptoms of substance use disorders and prevent relapse. Rates of relapse following treatment for substance use disorders are comparable to those of other chronic illnesses such as diabetes, asthma, and hypertension. More than 25 million individuals with a previous substance use disorder are in remission and living healthy, productive lives.”
In other words: The answer to “how does alcohol rehab work” is a complex one with a lot of moving parts, but with the right parts, at the right facility, and the willingness of the individual to get better, it most certainly does.