Last updated: 08/16/2021
Author: Susanne Reed, PhD, MPsy
Alcohol use disorders (AUDs) affect nearly 18 million people in America.1 You may decide to enter rehab when you recognize one or more of the 11 clinical criteria of an AUD impacting your life, such as spending an increasing amount of time on alcohol-related behaviors—including recovering from using alcohol—or experiencing withdrawal symptoms—such as sleep disturbance, sweating, and anxiety—when you do not use alcohol.2
The alcohol rehab that is right for you may depend on which AUD symptoms you are experiencing, as well as other factors such as your medical and mental health history.
In this Article:
Medical detox is a type of alcohol rehab program that gives you around-the-clock medical supervision and care during the initial phase of detox when withdrawal symptoms can range from mild to severe. When you enter medical detox, your doctor can prescribe a wide range of medications to ease the symptoms associated with withdrawal. By reducing the intensity of or eliminating your cravings and physical discomfort, your care team can help empower you to complete your full treatment plan, which gives you a higher chance of achieving long-term sobriety.3
Medications used in medical detox include:3
- Disulfiram (Antabuse)—Disulfiram triggers unpleasant symptoms if you drink alcohol. Within 10 minutes of consuming alcohol, you may experience nausea, vomiting, and skin flushing. Some individuals find these symptoms to be a valuable deterrent during early recovery.
- Naltrexone (Vivitrol and Revia)—Naltrexone works by inhibiting, or “blocking,” the pleasure and reward receptors in the brain that trigger positive sensations and emotions when you drink. It can also reduce cravings.
- Benzodiazepines—This medication includes Valium and Xanax, among others. Benzodiazepines treat anxiety and panic withdrawal symptoms, as well as seizures.
- Anticonvulsants—If you are at high risk of or have experienced seizures and convulsions during withdrawal, you may be prescribed a non-benzodiazepine anticonvulsant (NBAC).
- Behavioral health medicines—If you have a co-occurring mental health condition or are experiencing intense mental health symptoms during withdrawal, your doctor may prescribe antidepressants, antianxiety medications, antipsychotics, or other short- or long-term behavioral health medication.
If you have trouble sleeping, which is a common withdrawal symptom, your doctor can administer medicine to help. If you have headaches, nausea, or any other physical discomfort, you can be treated for those too.3
Many people in a medical detox program experience significant improvement in their first week. 4 You can work with doctors and counselors to determine other rehab programs that can continue to aid in your recovery.
After detox, you may still be vulnerable to relapse. While alcohol is no longer in your system, you can still have cravings and physical discomfort for weeks or months after detox. Medical detox also does not focus on providing tools you will need to maintain recovery long-term, simply on caring for you while you are medically vulnerable.4
Inpatient rehab is often called residential rehab. It is where you get 24-hour care with medication management in addition education and therapy. Inpatient rehab activities teach you early recovery skills, relapse prevention skills, communication skills, and conflict resolution skills. Through individual and group therapies, recovery education, and family therapy, you will develop recovery skills to use when you return home.4
Rehab programs use a variety of behavioral therapies to help you progress in your recovery. Behavioral therapies include the following:5
- Cognitive-behavioral therapy (CBT)—CBT is a form of talk therapy that teaches you how to change negative, inaccurate thinking to view situations as realistic so that you can respond to them more effectively.5
- Contingency-management therapy (CMT)—CMT is a form of therapy that gives you incentives and rewards for making positive changes and progress.5
- Motivational-enhancement therapy—Motivational therapy, including motivational interviewing (MI), helps you recognize how alcohol impacts your life and find personally meaningful motivation for recovery activities.5
- 12-step facilitation—12-step facilitation, which may be through an organization like Alcoholics Anonymous (AA), gives you guidelines and principles to overcome your AUD.5
Aftercare planning is a crucial part of your rehab program. When you are preparing to transition out of full-time residential treatment, your counselors work with you to determine the areas of your life that need continued support and put together an action plan. Aftercare planning may include: 6
- Alternative housing, such as a sober living home
- Vocational counseling
- Medical appointments and medication management
- Community support groups
- 12-step groups
- One-on-one, group, and family therapy
- GED or other educational counseling
- Legal assistance
Your aftercare plan may also include stepping down to an intensive outpatient program for continued recovery therapy, education, and support.
Intensive Outpatient Program
When you complete inpatient rehab, you will decide with the help of your counselors if you want to continue treatment in an intensive outpatient program (IOP).7 In some cases, a partial hospitalization program (PHP) may be recommended if your needs are similar to when you were in residential—such as requiring close medical supervision—but you are able to find stable sober housing. PHP is significantly more intensive than IOP.
Remaining in a semi-intensive program is recommended since you will be transitioning out of a clinical living facility, even if you are planning on living in a sober living house before you return to your main residence. This will be the first time you have been sober in less structured accommodations since you achieved your current sobriety.
While in inpatient rehab, you didn’t encounter the people, places, and things that are most likely to trigger a relapse. In a different environment, the restrictions and rules of residential do not exist. You may encounter some of the triggers you have not been exposed to since you started treatment.
IOP rehab programs offer several hours of daily support throughout the week and help you create a recovery support plan for the weekend. Participating in IOP gives you at least 10 hours a week of continued group and individual therapy, as well as recovery education and family therapy. 7 If your doctor has continued your medication, it can be managed through the IOP or transferred to a psychiatrist or your primary care doctor as appropriate.
Eventually, the amount of time you spend in a rehab program will decrease. Because you have spent months learning how to maintain sobriety, you will be more equipped for a successful recovery. Research has shown a correlation between the completion of your rehab treatment plan and positive recovery outcomes.5
Choosing a Level of Care
If you enter alcohol addiction treatment on the recommendation of a doctor, psychiatrist, or therapist, they may prescribe a level of care based on their observations. For example, if you enter rehab following a medical emergency in which you exhibit severe withdrawal symptoms, you are likely to be admitted to a medical detox center.
If you choose to enter rehab based on observations of your own AUD symptoms or the concerns of your loved ones, consider the physical and psychological signs for each level of care.
Medical detox is needed if you experience the following symptoms when you go without alcohol:8
- Shaky hands and excessive sweating
- Vomiting and/or diarrhea
- Mood swings
- Sleep disturbances
- Delirium tremens, which is characterized by tremors, agitation, confusion, heavy sleep, excitement, delirium, and seizures
Symptoms can develop as early as six hours after your last drink. You may benefit from medical supervision during withdrawal even if your symptoms are mild to moderate if your doctor recommends it based on your medical history or if you feel medication may help reduce your risk of relapse.8
Inpatient or residential rehab is needed if you need support and structure to help you build your recovery skills. Indicators that you may benefit from inpatient rehab include that you: 9
- Have a co-occurring disorder, such as major depression
- Have completed medical detox before, but experienced a relapse
- Live in a home environment that does not facilitate recovery
- Have not achieved and maintained sobriety in a previous outpatient program
- Need a high level of medical care
- Need continuing medication management following detox
- Are facing legal consequences that caused you to seek alcohol addiction treatment, either because such treatment was court-mandated or because you must maintain sobriety to comply with the conditions of a legal arrangement
An intensive outpatient program is needed if you have work or family obligations that do not allow you to leave home for inpatient treatment. This program will be a good fit if you do not require medically-supervised detox, but significantly more therapy than weekly counseling sessions. IOP may also be a good treatment option if you need time to continue developing coping skills, working on co-occurring disorders, and building a support system.10
Because recovery from an AUD is a process and not an endpoint, recovery extends past being abstinent and avoiding relapse. Participating in activities to maintain recovery long-term is referred to by some as building “recovery capital,” which is the protective factors that support your progress. Protective factors enhance your motivation to stay sober, improve your coping skills, and expand or enhance the quality of your support systems.11
Recovery capital can be gained through a variety of sober and recovery-focused activities, such as: 11
- Attending 12-step and peer support groups, such as Alcoholics Anonymous (AA) and SMART Recovery
- Exploring mindfulness, spiritual, and religious practices or daily rituals that you find meaningful
- Filling your life with activities that give you a sense of purpose, which could include anything from volunteering to spending time with your children to nurturing your garden
- Expressing yourself creatively
- Practicing self-care, both in practical ways (e.g., good sleep hygiene, joyful movement, checking in with yourself emotionally) and in simply pleasurable ways (e.g., dedicated time for reading, bubble baths, saving up for a special trip)
- Prioritizing your health as it relates to recovery, such as continuing with medication management for co-occurring diagnoses
Are you, or someone you know, trying to figure out which alcohol rehab program is right for you? Do you need help in deciding where to start treatment? We can give you the answers. Call our treatment specialists 24/7 at 800-926-9037 (Who Answers?).
- S. National Library of Medicine. (2021). Alcohol Use Disorder. MedlinePlus.
- National Institute of Health. National Institute of Alcohol Abuse and Alcoholism. (2021). What Are the Symptoms of Alcohol Use Disorder? Rethinking Drinking. Alcohol and Your Health.
- Center for Substance Abuse Treatment. (2006). Chapter 4 – Physical Detoxification Services for Withdrawal from Specific Substances. Treatment Improvement Protocol (TIP) Series, No. 45. Detoxification and Substance Abuse Treatment. Rockville (M.D.): Substance Abuse and Mental Health Services Administration (U.S.).
- Substance Abuse and Mental Health Services Administration. (2014). What is Substance Abuse Treatment? A Booklet for Families.
- National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).
- Proctor, S. L., & Herschman, P. L. (2014). The continuing care model of substance use treatment: what works, and when is “enough,” “enough?”. Psychiatry Journal, 2014, 692423.
- Center for Substance Abuse Treatment. (2006). Chapter 8 – Intensive Outpatient Treatment Approaches. Treatment Improvement Protocol (TIP) Series, No. 47. Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. Rockville (M.D.): Substance Abuse and Mental Health Services Administration (U.S.).
- Kattimani, S., & Bharadwaj, B. (2013). Clinical management of alcohol withdrawal: A systematic review. Industrial psychiatry journal, 22(2), 100–108.
- Center for Substance Abuse Treatment. (1997). Chapter 5 – Specialized Substance Abuse Treatment Programs. Treatment Improvement Protocol (TIP) Series, No. 24. A Guide to Substance Abuse Services for Primary Care Clinicians. Rockville (M.D.): Substance Abuse and Mental Health Services Administration (U.S).
- McCarty, D., Braude, L., Lyman, D. R., Dougherty, R. H., Daniels, A. S., Ghose, S. S., & Delphin-Rittmon, M. E. (2014). Substance abuse intensive outpatient programs: assessing the evidence. Psychiatric services (Washington, D.C.), 65(6), 718-726.
- Laudet A. B. (2008). The road to recovery: where are we going, and how do we get there? Empirically driven conclusions and future directions for service development and research. Substance use & misuse, 43(12-13), 2001–2020.