Some people can stop drinking on their own, more people will need some form of professional therapy, and most of us will require therapies on an inpatient basis. What do you need?

Alcohol abuse and alcoholism rob you of your health, your happiness, and your self respect and there is nothing wrong or even abnormal with wanting to tackle such a significant and entrenched problem with the most intensive and most successful form of therapy available, as in a residential setting.

However, due to the high cost, the disruption from work and the separation from family, most addictions professionals will recommend that most people start off with outpatient therapies as first attempt at bettering the problem.

In- or Outpatient Alcohol Rehab?

While participating in therapies on an outpatient basis you can maintain employment and continue to provide for your family. You can also be there to enjoy your family, tuck your kids in and spend time with your spouse. Outpatient therapy is also far less costly, and even those people unable to access state funded inpatient treatments may find that they can enter into outpatient programs, and often with no waiting period.

What is Outpatient Therapy?

You may participate in outpatient therapies of greatly varying intensity. At the most extreme, outpatient therapy encompasses whole days and differs little from inpatient with the exception that you return home each night to sleep. At the other extreme, outpatient therapy can be as minimal as free participation in 12 steps group meetings like AA, participation in a local peer support group, or weekly sessions with a psychologist.

Once you make the decision to enroll in outpatient therapy you can start within hours, literally. There are 12 steps meetings offered at all hours of the day in most major centers, and you can access this supportive therapy free of charge today.

Who Needs Inpatient Therapy?

But for some people, outpatient just doesn’t offer enough.

• If you have previously tried outpatient therapy, and found that you could not maintain sobriety, you need to consider inpatient therapy as a valid next step.
• If you have a very long history of intense abuse, you will find the first month or more exceedingly difficult while remaining in the environment of access and temptation, and you may want consider starting with a more intensive form of treatment.
• If you have any form of dual diagnosis you may not benefit from outpatient therapy. Dual Diagnosis challenges complicate treatment, and although dual diagnosis patients can and do better substance abuse problems, they often require inpatient care to do so.
• If you are pregnant, you need inpatient therapy.
• If you are in danger of losing custody of your children or if your spouse may leave you, you need intense inpatient therapy.
• If your drinking has started to have serious health consequences, you cannot take a chance, cannot waste any time, and you need residential rehab.

Go to a meeting today, get to rehab tomorrow

You can start outpatient therapy today. Get to a meeting, there is one in your area and even if you know that you need residential care, you have nothing to lose by seeking help this minute, and starting your journey back to health, even as you wait for residential care.

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The initial weeks and months after alcohol rehab are a time of great temptation and cravings. Three commonly used medications can help to reduce the strength of cravings, and help you stay sober.

Stubborn and varied, alcoholism requires a treatment as comprehensive as the disease is powerful, and for most alcoholics, no one therapy or intervention induces complete abstinence. Recovery rates are highest when alcoholics use a variety of therapies and medications for relapse prevention and eventual sobriety.

Naltrexone, Acamprosate and Disulfiram…

The existing medications for use in the treatment of alcoholism all remain imperfect, and there does not yet exist a magic bullet solution for the disease. No medications will work well without additional psycho social therapies and education, and no medications will work without an internalized desire to change and strength of will against temptation. But although imperfect, existing medications used in the treatment against alcohol relapse do offer some assistance in cravings minimization and relapse avoidance, and clinical studies have shown that patients treated with comprehensive drug and alcohol therapies, and also using a combination of relapse preventing medications, have the best eventual recovery rates.

There are three primary medications used in the treatment of alcoholism, and all are used after detox and therapies, and are used to assist the recovering alcoholic resist the temptations to relapse. The three most widely used medications used in the treatment of alcoholism are Naltrexone, Disulfiram and Acamprosate.

Acamprosate

The newest medication approved for the treatment of alcoholism, acamprosate works like naltrexone to reduce the intensity of experienced cravings. One major advantage of acamprosate over naltrexone is that it is not significantly metabolized in the liver, and as such can be effectively used even by patients with serious alcohol induced complications of the liver.

Acamprosate works through a mechanism of action within the glutamate systems of the brain. Chronic alcohol abuse leads to brain changes within the glutamanergic system, and disruptions within this system are one of the reasons why alcohol detoxification is so dangerous and can result in fatal convulsions. Acamprosate helps to stabilize glutamate activity in the brain for the first months after sobriety, allowing the brain to recover naturally and slowly, while reducing some of the discomforts of intermediate withdrawal symptoms.

Acamprosate has been found to reduce cravings to alcohol, and also seems to help people to sleep better during the first months of recovery (which is significant, as insomnia is a major contributor to relapse).

Acamprosate has been clinically proven effective, and some studies have shown that a combination of acamprosate and naltrexone offers the best protection against the cravings that lead to relapse and further abuse.

Disulfiram

Often sold under the trade name Antabuse, patients taking disulfiram will feel extremely sick if they drink alcohol concurrently with the drug. Disulfiram motivates alcoholics to avoid alcohol out of a fear of experiencing intense and unpleasant symptoms, similar to a severe hangover.

Disulfiram inhibits the body's ability to effectively process alcohol, and when the body cannot break down the consumed ethanol there is a resultant increase in the enzyme acetaldehyde in the blood. Acetaldehyde is the enzyme that creates many of the symptoms of an experienced hangover, so when patients consume alcohol concurrently with disulfiram, the almost immediate sensation is one of a very strong and unpleasant hangover.

The drug is very well tolerated, but can remain active for as long as two weeks after consumption is curtailed, and there are some dangerous drug interactions. The biggest problem with disulfiram therapy for relapse avoidance is that if patients feel sufficient compulsions to drink, they can simply stop taking the medication and can again drink without sickness soon after. Disulfiram is less widely used today than other alternative medications.

Naltrexone

Naltrexone is an opiate antagonist widely used in the treatment of both alcoholism and opiate addiction. Naltrexone reduces cravings and compulsions to drink through a mechanism of action within the dopamine mesolimbic pathways of the brain, also stimulated by alcohol.

Naltrexone reduces the pleasure associated with drinking, and also reduces cravings to use and abuse. The medication is very well tolerated by the vast majority of recovering alcoholics, and most people will not experience serious side effects after the first few days, during which time the body is becoming accustomed to the drug.

Naltrexone needs to be taken exactly as directed, and no opiates, even codeine containing cough syrups, can be taken concurrently with naltrexone. Most patients will use naltrexone for the first few months of sobriety, during which time the cravings back to use are strongest.

Naltrexone now has a long clinical history of efficacious use and numerous studies have shown that naltrexone, when used as a part of a more comprehensive alcohol treatment program, does increase the success rates of sobriety and long term abstinence.

No Medication is Enough Without Therapy

No one or even combination of medications seems to offer enough protection against relapse on their own, and any medication taken without accompanying therapy and education does not offer significant prevention against relapse. Taken as a part of a more comprehensive program of alcohol rehab and treatment though, these drugs do offer recovering alcoholics extra assistance in the battle towards abstinence and long term sobriety.

The difficulty in successfully overcoming alcoholism is such that any available tools in the arsenal of treatment need to be considered as worthy additions to a comprehensive program of recovery.

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When the drink has taken over, when nothing else works, and when you just can't stop on your own, it's time for alcohol rehab.

Alcohol Rehab

Most alcoholics cannot quit without professional help, and most of us need a real intense period of residential care, focused and intense therapies, and a month or more of enforced sobriety to have any chance at breaking free. It's just too tough to quit on our own.

We go to alcohol rehab for three basic reasons:

1. To get a safe and supervised period of medical detoxification
2. To learn why we need to drink and to better understand our motivations and abuse
3. To learn what we need to know to stay sober over the long term.

Detox without therapy rarely works, and so many of us endure uncomfortable detox on numerous occasions, never getting the tools we need to stay sober in the face of inevitable temptation.

Too many of us never fix those deep and rooted personal problems that led to abuse in the first place, and when we don’t better our issues, we have little chance of not repeating our mistakes.

Too many of us just don’t learn the tools we need to overcome triggers to use and powerful cravings to drink. These cravings are almost beyond our control, and unless we learn how to control our preconscious mind, we cannot hold much hope for long term sobriety.

It's tough to stay sober; if it were easy no one would need alcohol rehab. Don't ignore the obvious, don’t think that this time will be different, get the help you need to break free for good.

Alcohol Detox

Never detox on your own. Maybe because we can buy and drink alcohol legally we underestimate the risks of withdrawal and detox. Alcohol is one of the few drugs that can induce a detox so severe as to be fatal, and if you don’t get the medications you need to control the symptoms of withdrawal, you are at risk for convulsions, seizures and even heart failure.

You need to take it seriously, get the care you need to ensure a safe and comfortable detox, and get past the first step to recovery in a humane and effective way.

Although an unsupervised and unmedicated detox can be fatal, with proper medical supervision, care and medication; you can pass through detox relatively comfortably, and with very low risks to health.

Therapy, Learning Why You Drink

Without learning from your failures you are destined to repeat them. There is something in you that causes a compulsion to drink and to get drunk, and until you can understand and control your deep seated desires and issues, you cannot hope to stay sober for long.

Working with therapists in one on one sessions and through peer group therapy of support and discovery, alcoholics develop a greater self awareness over their personal triggers and causes to use and abuse. You may not solve all of your problems in a month of therapy, but by gaining self awareness you can retake control over your actions, and continue in the months and years ahead to better your issues…and better your chances of long term abstinence, heath and happiness.

Don’t ignore the importance of therapy. We are complicated beings and alcoholism is a very complicated and mysterious disease. You need all the tools at your disposal for any chance of beating your need for drink, and without gaining self awareness you cannot expect to stay sober for long.

Therapy, Learning How to Stay Sober

Once you pass from alcohol abuse to alcoholism, your disease gets a lot harder to beat. Once an alcoholic, the deep rooted influence of parts of your mind beyond your conscious awareness, and never-mind control, start to play a major role in your compulsion to drink.

While drinking, we may appear as though we choose our actions and that we choose to drink even when it does us harm, but in reality we act merely as puppets to the dance of our deep and unconscious mind, and we often have no awareness over the real and potent influence our preconscious plays.

Our mind will heal, and in time we can return to a normal state of functioning without the constant pulls to alcohol. To give ourselves the time we need to heal though, we need to learn effective strategies that will keep us away from temptations, will control our actions and even our thoughts, and will teach us just what to do when we find ourselves oh so close to taking that first drink.

It’s tough to stay off alcohol for good, and a lot of people never can. You need cognitive behavioral therapy, education, and learned concrete strategies that you will put into practice every day, and that will keep you sober to fight another day.

You can't control what you’re not even aware of, but you can use strategies proven to work, strategies that will keep you away from temptation, and strategies that will keep you sober in the face of incredible cravings and compulsions to use.

Other Benefits

Fundamentally we go to rehab to detox, to develop self awareness and to learn how to stay sober, but we benefit from some additional programs as well.

We start to restore our health in alcohol rehab, restore it through good nutrition and with vitamin supplements designed to reverse some of the damage of alcoholism. We also heal through exercise programming, through frequent medical care and through peripheral classes such as yoga or meditation, which salve our spiritual selves as they teach us greater mental control.

We also gain the support of other alcoholics in recovery and the inspiration of counselors working in the rehab, themselves recovering alcoholics, who show us what can and must be done.

Get Better in Alcohol Rehab

We go to rehab when things get bad. We go when nothing else seems to work and when we can't take anymore of a life of abuse, poor health and irresponsible actions. We go to rehab because a month or more of focused and intense participation in therapy gives us the strongest foundation for a better future, free from the pains of alcoholic chaos.

You can get better, it's gong to be tough and there are no guarantees, but committing to a full and honest participation in the therapies and education of alcohol rehab gives you the very best chance at a better and sober life.

You can do it.

If an afternoon in a doctor’s office and a few pills could save your life/keep alcohol withdrawal symptoms from progressing to dangerous levels, is it worth just doing it on your own? Read on for information on why you need medical assistance, what to expect from detox and how to predict the severity of symptoms.

Here’s a common attitude…”I’ll tough-out alcohol detox at home – and if things get too serious, then I’ll just head to the ER.”

OK... so this can work, but since things can slide downward faster than you might realize, this exposes you to a lot of very avoidable risk. Here are 4 good reasons to get a doctor involved right from the start:

• Alcohol withdrawal can kill you, so it’s worth taking seriously.
• Though you may think you could just head to the ER if needed, withdrawal symptoms can go from moderate to life threatening quickly and without warning.
• If you get medical management from the start, you can stop withdrawal symptoms from spiraling out of control – increasing the safety and comfort of the process.
• In most cases, you can detox safely at home, after spending a few hours getting medicated in a clinic or with your doctor – and in cases where this wouldn’t be an option – you definitely wouldn’t want to be detoxing on your own anyway.

Read on to learn more about what to expect from alcohol detox and about predicting your risks of serious (complicated) withdrawal symptoms, specifically:

• The risks of alcohol detox and what you can expect from the first few days
• Signs that indicate you’re at risk of serious withdrawals
• The CIWA-Ar – a common alcohol withdrawal screening tool that’s used to gauge the severity of the symptoms
• A common treatment plan
• Information on ambulatory (home) detox – are you an appropriate candidate to detox at home?

Why Is Alcohol Withdrawal Taken So Seriously?

Alcohol withdrawal can kill you. This is why anyone at risk of complicated withdrawals needs medical observation and prophylactic medications before symptoms get severe.

Severe alcohol withdrawal can lead to life threatening delirium tremens:

• Roughly 5% of people presenting with alcohol withdrawal symptoms will progress to a syndrome known as the delirium tremens, or the DTs. Left untreated, the DTs have a 15%-20% lethality rate, but with appropriate treatment, that rate falls to between 1% and 5%.¹

And the DTs are only one of many life-threatening scenarios to worry about. Other life-threatening complications can include:

• Accident trauma (you fall over and bang your head)
• Severe dehydration and electrolyte imbalance
• Seizures 
• Alcohol withdrawal symptoms combining with other conditions, such as diabetes, kidney disease or other acute infections²

Problematically, alcohol withdrawal symptoms can change quickly – going from mild to severe within a period of hours, not days.

Since symptoms can change quickly, and since you could go from moderate discomfort to life-threatening distress within a few hours, it’s important that anyone at risk of serious complications start out under medical observation, receiving medications that can stop serious symptoms before they get started.

Alcohol Withdrawal Symptoms

These symptoms occur due to CNS hyperactivity. Typical symptoms include:

• Mental symptoms like confusion, irritability, mood swings, depression, nightmares and anxiety or agitation.
• Physical symptoms like tremor and shakiness, headache, clammy skin, loss of appetite, nausea and vomiting, insomnia, fast heart rate, sweating and pallor

More severe symptoms Include:

Hallucinations

Hallucinations can be visual, tactile or auditory. If present, these typically occur from 12 to 24 hours after your last drink.

Seizures

• Seizures are usually generalized tonic clonic and if present, typically occur within 24 - 48 hours of your last drink.
  
• Roughly 2% to 3% of people in alcohol withdrawal will experience a seizure. You are most likely to have a withdrawal seizure if you’ve previously had a withdrawal seizure.
  
• Other significant risk factors for seizure include having had 3 or more significant periods of alcohol withdrawal, having drunk for 2 decades or longer, having a history of head injuries, being in poor health, being malnourished and presenting with electrolyte imbalances.³

Delirium Tremens

The DTs are characterized by severely altered mental functioning, extreme confusion, agitation, hallucinations and delusions, and usually occur within 24-72 hours of the last drink.

The Timeline

• You can start experiencing alcohol withdrawal symptoms from 6 to 8 hours after your last drink, or in serious cases, whenever your blood alcohol level falls below a certain point.
• For most people, symptoms will intensify to a peak at between 24 and 48 hours and then dissipate at between 3 and 5-7 days.¹
• Though acute withdrawal symptoms dissipate within a week, protracted or subacute withdrawal symptoms, such as insomnia, irritability and cravings can persist for many weeks.⁴

Are You at Risk of Severe Withdrawal?

In addition to an elevated CIWA-Ar score (see below to take the test), other signs that indicate a risk for complicated withdrawal include:⁵

High risk signs (at presentation):

• Having a body temperature of 101 Fahrenheit or greater
• Having a pulse rate of 115 or greater
• Having a systolic blood-pressure measurement of 170 or higher
• Experiencing alcohol withdrawal symptoms when blood alcohol levels drop to 0.15 or higher

Additional risk factors for complicated withdrawal:⁶

• Stopping after a period of drinking 20 or more units per day (13 or more standard drinks per day, such as 13 or more cans of regular strength beer.)
  
• Having a history of needing to drink in the mornings to stave-off withdrawal symptoms
• Abusing both alcohol and another substance – particularly benzodiazepines
• Having a history of complicated alcohol withdrawal symptoms
• Having concurrent physical or mental illness
• Being older

The CIWA-Ar

The Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar) is probably the most commonly used instrument to measure the severity of alcohol withdrawal symptoms – If admitted to a hospital with suspected alcohol withdrawal, you’d almost certainly get measured for a CIWA-Ar score.⁷

For your education only (it’s not a good idea to try to self-doctor yourself through alcohol withdrawal) here is the measurement scale. Take the test yourself, or better yet, have a loved one ask you the questions and help you through it.

Pick the numerical score for each of the 10 categories that best represents your current experience, and at the end of the test, add up your scores. The maximum possible score is 67, but anything over an 8 indicates a possible need for medical intervention.

If you take this test and score above 8-10, take this seriously and get medical help right away!

Nausea and Vomiting

no nausea and no vomiting mild nausea with no vomiting intermittent nausea with dry heaves constant nausea, frequent dry heaves and vomiting

Tactile Disturbances

Do you have any itching, pins and needles sensations, any burning, any numbness, or do you feel bugs crawling on or under your skin? none very mild itching, pins and needles, burning or numbness mild itching, pins and needles, burning or numbness moderate itching, pins and needles, burning or numbness moderately severe hallucinations severe hallucinations extremely severe hallucinations continuous hallucinations

Tremor

With you arms extended and fingers spread apart. no tremor not visible, but can be felt fingertip to fingertip moderate, with patient's arms extended severe, even with arms not extended

Auditory Disturbances

Are you more aware of sounds around you? Are they harsh? Do they frighten you? Are you hearing anything that is disturbing to you? Are you hearing things you know are not there? not present very mild harshness or ability to frighten mild harshness or ability to frighten moderate harshness or ability to frighten moderately severe hallucinations severe hallucinations extremely severe hallucinations continuous hallucinations

Paroxysmal Sweats

no sweat visible barely perceptible sweating, palms moist beads of sweat obvious on forehead drenching sweats

Visual Disturbances

Does the light appear to be too bright? Is its color different? Does it hurt your eyes? Are you seeing anything that is disturbing to you? Are you seeing things you know are not there? not present very mild sensitivity mild sensitivity moderate sensitivity moderately severe hallucinations severe hallucinations extremely severe hallucinations continuous hallucinations

Anxiety

Do you feel nervous? no anxiety, at ease mild anxious moderately anxious, or guarded, so anxiety is inferred equivalent to acute panic states as seen in severe delirium or acute schizophrenic reactions

Headache, Fullness in Head

Does your head feel different? Does it feel like there is a band around your head? not present very mild mild moderate moderately severe severe very severe extremely severe

Agitation

normal activity somewhat more than normal activity moderately fidgety and restless paces back and forth during most of the interview, or constantly thrashes about

Orientation and Clouding of Sensorium

"What day is this? Where are you? Who am I?" oriented and can do serial additions cannot do serial additions or is uncertain about date disoriented for date by no more than 2 calendar days disoriented for date by more than 2 calendar days disoriented for place/or person

Interpreting Scoring

A score of:

• 0 to 9 indicates no or very minimal alcohol withdrawal
• 10 – 19 indicates mild to moderate alcohol withdrawal (Some groups, like the VA, consider 15 the upper cut-off for moderate withdrawal)
• 20+ indicates severe withdrawal (The VA considers a score of 15 or more indicative of severe withdrawal)⁸

Relating scoring to treatment:

• Scoring over 8 indicates a possible need for medications.
• Early intervention (the early use of certain medications, such as benzodiazepines) can keep withdrawal symptoms from progressing to a dangerous levels.
• Some people who score low on the CIWWA-Ar go on to have complicated withdrawals regardless (this speaks to the danger of self diagnosing your situation and limiting medical involvement in the early stages.)
• People scoring over 35 may require treatment in an ICU

Treatments to Reduce the Dangers

Your individual treatment will depend on your individual situation, alcohol use history, physical and mental health and use of other drugs – but in general, most people in alcohol withdrawal who score high enough on the CIWA-Ar to warrant medication receive spaced (loading) doses of diazepam (or similar) until symptoms dissipate or you feel sedated.

For example, according to the Canadian Centre for Mental Health and Addiction, people in alcohol withdrawal needing medication should⁹:

• Receive 20 mg of diazepam every 1-2 hours until symptoms abate. If withdrawal symptoms persist after 80 mg of diazepam, hospitalization is indicated.
• If there is any history of withdrawal seizure, the person should receive at least 3 time-spaced 20 mg doses of diazepam.

People coming off extended binges can have severe dehydration and electrolyte imbalances. Certain symptoms of withdrawal – such as heavy sweating, vomiting or diarrhea – can exacerbate this situation. Maintaining fluid intake is essential, and in some cases, this may require I.V. rehydration.¹⁰

When Is the Danger Past?

According to the Center for Mental Health and Addiction, people who score less than 10 on 3 consecutive  CIWA-Ar assessments – each separated by a period of hours – no longer need retesting, though they still need informal monitoring to ensure no reemergence of symptoms. 

Ambulatory (Home) Detoxification?

People who aren’t expected to experience severe or complicated withdrawal symptoms can generally stay at home throughout the process (an ambulatory - detox), while checking in with a doctor periodically (likely daily) for evaluation.

You may be a candidate for ambulatory detoxification if:

• Your doctor doesn’t expect severe or complicated withdrawals.
• You can travel relatively quickly and easily to a hospital or clinic if need be (if you live 3 hours from the nearest doctor you may not want to try this at home).
• You have a stable support person willing and able to help monitor your progress through the period and able to summon help/transport you if need be.

Ambulatory detox is obviously much more affordable than hospitalization. If you decide on ambulatory detoxification, you will probably:

• Spend several hours in a doctor’s office or clinic on the first morning (after having had your last drink the evening before) getting medicated until your symptoms are under control.
• Have to return to the office or clinic the following day for reevaluation.
• Be given instructions for warning signs of worsening withdrawal to watch for, such as confusion or hallucinations (a warning sign of impending DTs), fever, etc.¹¹

Caution – You will feel very shaky during withdrawal and this can frequently lead to accidents around the home, which can be small (spilling hot coffee on yourself) or larger (falling in the bath and banging your head). Please take extra care during these few days to avoid making an already tough situation worse.¹²

Image Copyright: Gisella Giardino

When evaluating available alcoholism treatments, you will quickly need to decide whether you need long term stay at a therapeutic community or the more intense therapies of a briefer stay at an alcohol rehab. Whichever you decide, don't wait....check in tomorrow, get sober tomorrow.

What's the Difference Between an Alcohol Rehab and a Therapeutic Community for Drug or Alcohol Addiction Treatment?

Where Should You Go?

When people with substance abuse problems consider a residential facility for the treatment of an addiction, they are faced with a choice between two very distinct models of treatment. An alcohol rehab facility will generally offer shorter periods of very intensive professional therapy and enforced sobriety, and a therapeutic community will offer a very long period of structured living and therapeutic involvement in an orderly community based model of recovery. An alcohol rehab program may finish in as little as 28 days, and rarely exceeds three months, but therapeutic community treatment offers long term care, generally from 12 months to 2 years.

Why Such a Difference in the Length of Involvement?

The two types of residential drug treatment have slightly different goals, and as such require different lengths of involved participation to achieve their aims.

An alcohol rehab facility is exclusively designed to help people overcome a physical or psychological addiction to drugs or alcohol, but does not offer much in the way of general living skills training or support. A therapeutic community also exists to help people overcome an addiction, but also recognizes that many of the people suffering from a dependency to drugs or alcohol lack basic socialization and life skills, and that without first learning (or re learning) these necessary skills they are at great risk for a relapse back to abuse.

Because the therapeutic community attempts a far more ambitious program of personal change and growth, by necessity, the programming needs to be far longer lasting.

How Does the Therapeutic Programming Differ Between Rehab and Therapeutic Community?

The types of professionally run therapies offered do not differ much between the two models of residential treatment. Both will offer 12 steps meetings for recovery, individual sessions with a psychologist or addictions professional, peer support group programming, and cognitive behavioral education and training.

Intensity of Therapies

Although the two types of facilities will offer the same types of programming, the intensity of therapeutic programming does differ. An alcohol rehab facility aims only to teach the needed life skills and strategies to end drug or alcohol seeking behaviors, and as such the brief period of residency is therapeutically intense. Residents will participate in differing therapies and education classes exclusively, and will not be required to do anything during the period of recovery other than focus on self healing.

A therapeutic community will offer the same types of therapies, but with a lesser intensity.

Firstly, because residents are expected to maintain participation for as long as two years, there is not the pressing need to teach all needed skills within a shorter duration of residency; and more importantly, the basic philosophical model of treatment has recovery and therapy occurring more out of participation and interaction in the community than through top down addictions programming.

Working While in Treatment

An essential part of a therapeutic community is a full participation in work responsibilities and in the running of the community. Through a regimented and hierarchical participation in the running of the community, residents gradually learn how to better live in society as they also learn the strategies needed to stay drug or alcohol free.

Through rigid and orderly participation in a very structured community, patients learn how to follow rules and observe norms of behavior, how to work for, with and eventually supervise other members of the community; and how to socialize in appropriate and constructive ways with others in the community. The essential goal of the therapeutic community is not only drug or alcohol avoidance, but a complete re socialization of appropriate behaviors required to participate constructively and soberly in society.

Which Type of Program is Right for You?

Although drug or alcohol addiction and the behaviors of abuse can impact on familial and professional relationships, those people who have managed to stay relatively involved in society and the community likely do not require the more intensive treatment as offered at a therapeutic community.

• Some patients have either never appropriately learned how to participate in society, or have been abusing drugs or alcohol for so long that they need to intensively relearn these social skills; and for these people, a therapeutic community is likely the better option.
• Patients with an existing social support network (family, non abusing friends) often benefit more from a brief participation in a rehab.
• Patients with severe mental conditions co occurring with addiction often benefit from the slower and more comprehensive style of recovery and socialization as offered at a long term therapeutic community, and likewise, people with severe histories of addiction, and multiple failed attempts at standard drug rehab, may also benefit more from a therapeutic community.
• Many of the residents in a therapeutic community are mandated to participate through judicial involvement.

Residents benefiting most from a participation in a therapeutic community tend to have more severe, longer and more antisocial histories of addiction, more criminality and less family or peer support. They also tend to have greater rates of dual diagnosis addictions.

Which Type of Treatment Works Better?

The recovery rates do not differ substantially. The people most often seeking out treatment at a therapeutic community generally have more intense and longer histories of abuse and addiction, and require a much longer and more intensive period of residency; and although they spend far longer in therapeutic recovery, because of the difficulty in treating severe addictions, they do not show greatly better recovery rates as a result.

What is most important is that addicts get treatment in a facility most appropriate and suited to their history of abuse and addiction. Patients who maintain some family or peer support, who can still function in society, and who do not suffer from a severe dual diagnosis; are much better treated at a conventional alcohol rehab facility.

Image Copyright: Tiago Ribeiro

Few people make a decision to quit alcohol for good before resolving feelings of ambivalence about drinking – after all, if there wasn’t something we enjoyed about alcohol then why would anyone ever develop a problem?! Read on to answer a few quick questions that should help you to clarify what is that you like and don’t like about drinking and what it is you’d like and not like about quitting – so that you’ll develop a better idea about whether you are ready to quit for good!

Many people delay or avoid alcoholism treatment for a couple of reasons:

1. You feel like you can’t succeed
   
2. You have some ambivalence about changing
   

If you are like the overwhelming majority of people who abuse alcohol, at least one of the above statements likely describes your situation. Read on then to answer a couple of questions that might change your thinking on your ability to change and complete a brief exercise to help you organize your thoughts on ambivalence about change.

Could You Stop Drinking If You Wanted To?

Maybe you think you can't stop. Maybe you’ve tried before, maybe on many occasions before, and you’ve never been able to quit for long. Maybe you’ve been drinking for so long that it’s just a part of who you are now and you wouldn’t know how to live anymore without the drinking…

Whatever the reasoning, a belief in the possibility of change is an important step towards taking action for change, but before you say it’s impossible, ask yourself the following question:

• Could you stop drinking if you were going to be paid $1 million for a day or $10 million for a week or $50 million for a lifetime to do so, so long as you maintained complete abstinence?
  

If you answered yes then you know that quitting is possible, it may be very hard to accomplish, but it is not impossible.

Now make a list of the things you would have to do to succeed in quitting drinking for a day or a week or forever:

1____________________

2____________________

3____________________

4____________________

Are You Ready to Change?

Hopefully after answering the million dollar question above you can recognize that quitting drinking is not an impossible task and that if you had sufficient motivation to do so you could probably put down the drink for good.

Quitting is hard,  but the 10’s of millions of recovering alcoholics walking the streets of America right now – and at least some of them were surely drinking harder than you are today – argues convincingly to the possibility of change.

So the question really isn’t can you change; it’s, are you ready to change?

Few people would become alcoholics if there weren’t at least some things they enjoyed about drinking, and so for most people, making a decision to change also means making a decision to give up the pleasures associated with drinking alcohol – and this can create some significant ambivalence.

You need to decide if:

1. The positives of quitting outweigh the positives of continuing to drink
   
2. The negatives of continuing to drink outweigh the negatives of quitting
   

Answering these questions and weighing the positives and negatives should help you to resolve ambivalence and make a decision to seek change, or to stay as you are. To get started, complete the following quick exercise.

1. Make a List of the Positives Associated with Continuing to Drink

For example, I enjoy the taste of wine, I feel more relaxed and confident after a few drinks, I have a lot of fun when I go out drinking with my friends etc.

2. Make a List of the Positives Associated with Quitting Drinking

For example, my health would improve, my children would respect me more, I’d save a lot of money, I would look younger etc.

3. Make a List of the Negatives Associated with Quitting Drinking

For example, I couldn’t hang out with my best drinking friends any more, no more going to wine tastings and other social gatherings with alcohol etc.

4. Make a List of the Negatives Associated with Continuing to Drink

For example, my liver function and high blood pressure will continue to worsen, I am likely to continue to get into trouble with the law for DUIs, I will continue to be a poor role model to my children, my wife may not stay with me etc.

There will always be ambivalence, but once you have made a fairly comprehensive listing of the pros and cons of quitting or staying as you are, it may be easier for you to choose the course of action that makes the most sense for you.*

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No one form of therapy works well for everyone, and that's why the best alcohol rehabs provide a very comprehensive base of treatments, including some that don't at first seem all that related to overcoming addiction...but can help a lot.

The benefits of peripheral classes in alcohol rehab. How exercise, meditation, karate and nutrition classes help to prevent relapse.

Holistic Alcohol Rehab

Classes on nutrition, exercise and on activities such as yoga, karate or meditation serve an important role in long term relapse prevention.

Alcoholics entering into a residential alcohol rehab facility have a lot of work to do, and a relatively brief period in which to accomplish all of the learning needed. But even though the therapeutic time is limited, and addictions professionals try to offer as much comprehensive and varied therapy and reflection time as possible, an important part of any alcohol rehab program are the peripheral classes on general health and nutrition. These peripheral classes provide recovering alcoholics with the knowledge and habits they’ll need to have the best odds at maintaining achieved abstinence.

The Problem of Relapse

Unfortunately, more than half of all people completing a successful period of residential rehab will relapse to some degree during the initial year of sobriety. The first year is very tough, and the body and mind take a long time to completely heal from the ravages of alcohol abuse. Brain activity remains altered by the legacy of abuse for many months after achieved abstinence, and this strengthens compulsions and cravings back to use and abuse.

Learning to Beat the Cravings

Additionally, the societal cues to alcohol abuse are everywhere. A cocaine addict may be able to significantly minimize temptations to cocaine abuse by avoiding people and environments of past and present use, but recovering alcoholics can hardly avoid the societal cues to drinking. In every grocery and convenience store there is alcohol for sale, on every street corner is a billboard for alcohol, on television we are bombarded with beer commercials and any time we go to a restaurant or social function we are asked what we'd like to drink!

It can be very hard for recovering alcoholics still feeling strong cravings and compulsion to use to overcome this seemingly endless barrage of temptation and easy access, and strong willpower alone isn’t really enough.

To make the transition to sobriety easier, alcohol rehab takes time out of busy therapeutic programs to offer classes on good nutrition, on exercise, and on general health topics. In AA they use HALT, which is when you are hungry, angry, lonely or tired, you are more likely to relapse; and in alcohol rehab professionals work with addicts to teach them how to avoid these feelings during initial sobriety.

Nutritional Classes in Alcohol Rehab

Alcohol rehabs try to mend the body, mind and soul; and alcoholics commonly enter into rehab having neglected their body through poor nutrition, and through the effects of alcohol on the gastro intestinal system. The long term legacy of the nutritional deficits of alcoholism can include irreversible brain damage, osteoporosis, heart failure and gastro intestinal disorders; as well as an increased risk for a number of cancers. Additionally, not eating right makes you more prone to relapse.

Alcohol rehabs work hard to provide meals brimming with the kinds of nutrients that alcoholics in recovery need most, but a month or two of rehab won’t erase severe nutritional deficits, and alcoholics need to learn how they can continue to eat to better their health, and also to lessen their risks of relapse.

Learning to Eat Better; Staying Sober

Nutritional classes teach alcoholics about the vitamins and nutrients they are likely lacking, the health problems associated with nutritional deficiencies, and also what types of foods and meals are best able to restore their levels of nutritional health. Vitamin and nutrient supplements are also used, and recovering alcoholics will be counseled on which types of vitamin supplements they should continue taking, and for how long.

Hypoglycemia

Hypoglycemia (low and variant blood sugar) is a very common problem afflicting recovering alcoholics, and is a primary cause of relapse. Alcoholics with a heavy history of drinking often develop this condition of swinging and crashing blood sugar levels; and when blood sugar levels fall, they experience depressed mood, lethargy, and also cravings for sugar…which for alcoholics means cravings for the sugar in alcohol!

Alcoholics are taught that a great way to minimize the cravings back to relapse is to avoid ever feeling hungry, and by never letting blood sugar levels fall. Recovering alcoholics are advised to eat as many as 6 easily digestible and nutrient rich meals daily, and to always carry around a bit of candy…for emergency situations of craving!

Exercise Classes in Alcohol Rehab

Exercise causes a release of endorphins, helps to fight off periods and feelings of depression, and helps to fatigue the body…assisting in dealing with problems with insomnia so often a part of early alcohol recovery.

The multiple benefits of exercise in recovery make exercise programming in alcohol rehab an important and worthwhile therapeutic addition to a comprehensive experience. Recovering alcoholics are taught necessary exercise skills and are encouraged to get into the habit of mood buoying exercise while participating in alcohol rehab, in the hopes that they will continue with therapeutic exercise during the initial months of sobriety outside of the temptation free safety of the rehab environment.

Yoga, Karate, Meditation…Other Peripheral Classes in Alcohol Rehab

People sometimes wonder at the therapeutic value of seemingly unrelated classes such as karate or yoga, but a major contributor to relapse is experienced stress and poor stress management techniques. Since many alcoholics, especially alcoholics with a long history of drinking, have used alcohol as a stress management technique for years; they need to learn appropriate and healthy strategies of stress and lifestyle management.

Yoga, karate and meditation classes all require a discipline of the mind and body, all offer recovering alcoholics a greater insight of self awareness; and all induce a more peaceful state of mind that endures far beyond the physical act. Through mental self reflection and psychical training, recovering alcoholics gain a better perspective over the life stressors that might otherwise contribute to relapse.

HALT… Hungry, Angry, Lonely and Tired

Whether or not an alcohol rehab facility subscribes to the AA mantra against HALT, quality rehab programs do offer comprehensive classes and education that help recovering alcoholics to minimize relapse through better bodily and emotional control.

Good nutrition and blood sugar management helps to keep recovering alcoholics from feeling the lethargy, depression and cravings back to alcohol use and abuse, as it also helps to restore better overall health.

Classes and practicum's that promote regular exercise as a therapeutic aid get recovering alcoholics in the habit of using the mood lifting effects of exercise to reduce the depression and dysphoria that can lead to abuse. Additionally, regular exercise can help to offset some of the relapse provoking insomnia that is so often a part of early sobriety.

Peripheral classes such as meditation or yoga give addicts better self awareness, and through mental training, better self control. Using skills learned, addicts are better able to deal with normal life stresses, and can minimize negative emotions such as anger that always provoke cravings back to use and abuse.

Avoiding relapse is very tough, especially during the first year of sobriety, and to give recovering alcoholics the best chance of success and sobriety, an alcohol rehab program needs to leave recovering alcoholics with a diverse set of life skills that minimize cravings, and help to deal with cravings that do emerge. Therapy and counseling are a central part of a rehab experience, but peripheral programs are also significant, and the quality of peripheral programs should be a factor to consider when evaluating different alcohol rehab facilities.

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The vast majority of alcoholics never get help, and most never want it; but there is a significant number of people who know they need help and want to change, but for few reasons, feel they cannot get into rehab. Here's how to overcome these barriers to treatment, get help and get sober.

300 000 Americans want alcohol rehab treatment, but are worried about the costs and stigma…why alcohol rehab always saves money over time.

Why So Many Don't Get the Help They Need

A recent report by the National Survey on Drug Use and Health (NSDUH) on alcohol and drug abuse and treatment needs, puts the number of Americans who currently need treatment for alcohol abuse behaviors or alcohol dependency at a staggering 18.6 million people.

Disturbingly, although almost 19 million people are in desperate need of intervention and treatment, only about 8% per year will ever attempt treatment, and of the remaining 92% of alcoholics or alcohol abusers, only 4.5% perceived a need for treatment.

Denial

Almost 9 in 10 alcohol abusers or alcoholics maintain a mindset of denial and don’t feel they have any need for treatment; and this denial contributes to our massive societal problems with alcohol abuse and alcoholism; and this needs to be addressed within the family and within the community. There are very effective strategies to convince reluctant users of a need for treatment, and families wanting to learn more should read up on interventions as a way to induce treatment compliance.

But although only 4.5% of alcohol abusers or alcoholics perceived a need for treatment but did not get any, that still represents well over 700 000 people ready for help, that for a couple of reasons do not seek it, and continue to drink.

Perceived Barriers to Participation in Alcohol Rehab

Of those people who do realize that their drinking is problematic, and realizing that they do require professional help and intervention, almost half say that they do not seek out help because they are not yet ready to stop drinking. About 40% say that the costs of treatment prohibits participation, and almost 24% say that fear of the stigma of being labeled an alcoholic contributed to their decision against treatment. A further 13% said that they simply did not know where to get help.

So even if almost 17 million people deny their problems, and a further 400 000 admit to a problem, but aren’t ready to seek help, we are still left with more than 300 000 people who want help, would gladly get it; but for fear of the costs or stigma, or of simply not knowing where to go, continue to drink without attempts at treatment.

Although 300 000+ is nowhere near the more than 18 million who need treatment, it is still a very substantial number of people ready for help…and these people need to be encouraged to get it.

Overcoming the Barriers to Alcohol Rehab Treatment

Stigma

Although alcoholics worry about the stigma associated with alcohol rehab or other treatments, legislative statutes exist to protect the confidentiality of treatment. The reality is that alcoholics in treatment are under no obligation to inform anyone of their participation, and most employers are compelled by law to grant a leave of absence from work without punishment for medically necessary treatment. Most Americans can access up to 12 weeks of confidential medical employment leave, no employer can legally break confidentiality, and no future employer can even legally inquire about past treatments.

Alcoholics need not worry about the stigma associated with treatment, and may choose to remain completely silent about any participation, and that right is enforced by law.

Knowing Where to Get Alcohol Rehab

With many hundreds of state accredited private and public institutions offering comprehensive alcohol rehab across the United States, not knowing where to turn for help is very unfortunate, and completely unnecessary. A local physician or health services agency can always recommend a suitable and local treatment center, and treatment information can easily be accessed through the internet. Choosehelp counselors can also assist in recommending appropriate treatment to those unsure of where to turn.

Costs

The costs of an alcohol rehab stay deter hundreds of thousands of otherwise willing participants from treatment each and every year. Alcohol rehab is expensive, and better quality private alcohol rehabs can cost upwards of $20 000 per stay.

Most people with some degree of private health insurance will find that their insurance provider will offset some or all of the costs of a rehab stay, but for those people without any supplementary health coverage, there are a number of available options to assist those unable to afford such a large upfront investment.

Lower income participants may be eligible for public subsidies to treatment, or for participation in a public rehab program. Many private rehab facilities will work with people lacking health insurance, and will either reduce the costs of treatment, or will offer payment plans acceptable to all involved.

Even if a participant is forced to defray the entire cost of a residential rehab stay, if sobriety is achieved after an intensive and committed participation in rehab, the long term savings will quickly more than equal any initial costs of treatment.

The True Costs of Not Getting Help

Alcohol is expensive, and an alcoholic spending less than 20$ per day on alcohol is surely in the minority; but even if only 20$ per day is spent on alcohol, the costs mount to more than $7000 per year…and in a mere three years the savings from alcohol alone would pay for some of the finest treatment in the nation.

But alcohol costs are only one of the many expenses related to alcohol abuse and alcoholism. Research proves that alcohol abusers are far more likely to live in a bad neighborhood and perform poorly at work…and those people who stop drinking are far more likely to move into a better neighborhood. People who achieve sobriety can expect to perform far better at work, and excel financially.

Health care savings also mount with sobriety, and the long term savings from quitting drinking can be astronomical. Alcohol abuse and alcoholism ravages the body and mind, and greatly increases the risks of a number of cancers, heart disease, diabetes and mental deficits. People achieving a healthier lifestyle of sobriety will save many tens of thousands of dollars over a lifetime of better living.

Less peripheral costs…alcohol abuse and alcoholism is often associated with unpleasant and costly participation in the criminal justice system. Through sobriety and less public intoxication, the risks of criminality and associated legal expenses are greatly reduced.

A participation in a residential alcohol rehab should be considered an investment in a future of better health and better financial status. With the possibilities of long term payments or loans to defray initial costs of access, using the costs of rehab as a barrier to entry does not really make much sense over the long, and even not so long term.

The Cost of Rehab…a Necessary Evil

No one wants to pay the equivalent of the cost of a new car for medical treatment, but when a problem with alcohol abuse or addiction becomes serious enough to demand professional alcohol rehab, nothing less offers much hope for a better and more productive life of sobriety.

The costs associated with running a comprehensive alcohol treatment facility disclude the possibility of bargain rehab; and a quality facility must house and feed residents in a comfortable and private manner and must employ a legion of trained counselors, doctors, nurses, psychologists, nutritionists and other professionals…all who demand and deserve high salaries, and who are all completely necessary to ensure quality programming offering a best chance at sobriety.

Nothing about alcoholism or alcohol abuse is free from pain, and that includes the difficulty of funding needed treatment; but if the burden can be met, the long term benefits always outweigh short term financial hardships, and a better life of sobriety, productivity and better health always justifies the initial costs.

All alcoholics and alcohol abusers need and deserve intervention and medical treatment, but the reality of denial is such that far too many continue to abuse without even acknowledging the existence of a problem. For those in the very small minority (that still number into the hundreds of thousands) that do recognize a need for treatment, we need to make sure that the barriers to access are lowered, and convince those requiring of help to enter a residential alcohol rehab program sure to have a great long term benefit.

Image Copyright: Tracy O