What Is Alcohol Rehab?
KEY TAKEAWAY
Alcohol rehabilitation is the medical or therapeutic treatment of alcohol dependence (alcohol use disorder).
The rehab process aims to enable the patient to stop alcohol intake and take responsibility for alcohol addiction.
Most treatment involves alcohol cessation including detoxification. Pharmacological intervention is followed by psychosocial support to improve the reactions which led to alcohol misuse.
Treatment normally aims to resolve underlying psychological factors behind alcohol use disorder to prevent further negative consequences in the patient's life.
Alcohol Use Disorder & Alcohol Abuse
DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) attributes the cause of alcohol use disorder to approximately 50% environmental factors and 50% genetic factors. [1]
Since 2013, an alcohol use disorder diagnosis may include alcohol dependence (ICD-11) and alcohol abuse. [2]
In the UK, the National Institute for Health and Care Excellence (NICE) provide specific recommendations for the treatment of alcohol use disorder and alcohol addiction. [3]
Types Of Alcohol Dependence
Physical Dependence & Withdrawal Symptoms
Long term alcohol abuse changes the brain's structure, and neurotransmitter function. [4]
These imbalances leave the addict's brain more prone to relapse, even after the detox phase is complete.
Ceasing intake abruptly without pharmacological help can result in Alcohol Withdrawal Syndrome. [5]
Medication can be used to detoxify the body following cessation, or to discourage further drinking in future.
Detoxification Medications
Benzodiazepines
Benzodiazepine drugs are used in residential clinics to manage common symptoms after the last drink.
Prescribed by medical professionals, diazepine drugs can be used to mimic the chemical effects of alcohol in the brain.
Diazepam may be used, on a "sliding scale" reduction of dosage, to minimise physical withdrawal symptoms.
Chlordiazepoxide, also known as Librium, is often used in residential settings for detox purposes due to the long half-life of its metabolic products (desmethyldiazepam).
Medications To Discourage Further Drinking
Naltrexone
Naltrexone (Revia)(Vivitrol) is an opioid antagonist used to reduce the pleasurable feelings that commonly occur with drinking.
Sinclair Method
The Sinclair method is a form of deconditioning, which reduces the positive feelings people experience from drinking.
The Sinclair Method involves taking a single dose of Naltrexone one hour before drinking.
The antagonist effects of Naltrexone reduce the pleasurable feelings obtained from drinking alcohol.
It can take 3-9 months for users of the Sinclair Method to achieve reduced desire to drink alcohol.
Nalmefene
A derivative of Naltrexone, Nalmefene (trade name Selincro), is an opioid antagonist.
NICE recommends combined use of Nalmefene with psychosocial support to reduce alcohol consumption.[6]
Acamprosate
Acamprosate rebalances neurotransmitter levels in the brain after you stop drinking.
Excess glutamate is released during cessation from alcohol, and Acamprosate works as an antagonist on glutamate receptors.
Disulfiram
Disulfiram (Antabuse) is a drug which stimulates sensitivity to alcohol by inhibiting enzymes the body normally uses to break it down.
Disulfiram usage results in experiencing symptoms and negative effects of acute hangover very quickly.
In this way Disulfiram acts as a deterrent to continued intake.
Psychological Dependence
Psychotherapy and behavioural therapies are used to tackle the underlying psychological symptoms behind alcohol addiction.
Rehabilitation centre programmes commonly include psychosocial support such as individual therapies, Twelve Step programmes, cognitive behavioural therapy (commonly referred to as CBT), and relapse prevention planning.
Communities such as AA, and SMART Recovery extend social support into the community environment.
Types Of Alcohol Addiction Treatment
The alcohol rehabilitation treatment process differs based on the type of addiction help being sought.
Outpatient Rehab
How does outpatient treatment work?
Outpatient treatment is considered suitable only for individuals at low risk of withdrawal symptoms.
Treatment programme components are based on individual needs, and usually do not include any residential element.
Private outpatient treatment may consist of antagonist medication combined with psychotherapy.
Local authority outpatient alcohol rehab centres usually include regular keywork meetings with an assigned case worker or clinical manager.
Activities in outpatient treatments will include goal setting, and a managed care plan for reducing intake over time.
Outpatient rehab programmes normally last 3-6 months or longer.
Outpatient programmes usually involve more self-managed aspects of care, compared to a residential treatment centre.
Inpatient Treatment Centres
Inpatient rehab clinics are most suited to people at high risk of withdrawal symptoms or delirium tremens.
A 2020 survey by Recovery Village suggests that 34.9% begin their recovery journey in residential or inpatient treatment. [7]
Residential Alcohol Rehab
Rehabilitation clinics ("rehab") are a type of live-in treatment unit providing detox and psychotherapy for addiction.
Some alcohol rehab clinics also offer treatment for the mental health disorders associated with alcohol addiction, in an integrated programme.
Residential alcohol treatment facilities frequently provide behavioural interventions and family support programmes.
An alcohol rehab clinic will usually include setting up supports to avoid regression to addictive behaviours in future.
Alcohol Addiction Treatment Programme
A structured alcohol rehab programme can contain multiple treatment approaches.
People suffering from alcoholism usually need a multi-faceted physical and psychological programme, run by experienced professionals, and including medical assessment.
Abstinence
Alcohol addiction treatment centres usually require clients to commit to abstinence. This means living an alcohol free life, indefinitely.
A 2007 study found that abstinence was the most stable means of maintaining recovery from alcoholism over time. [8]
Living an alcohol free life long term, means reward pathways of the brain can begin to recover normal function. [9]
Alcohol Detoxification
Alcohol addiction treatments normally begin by completing safe detox and withdrawal. Medical treatment helps to minimise unpleasant withdrawal symptoms.
Prescription drugs such as Benzodiazepines are frequently prescribed by a medical professional to minimise risk of withdrawal symptoms occurring.
Psychotherapy
Beyond the surface symptoms of dependency, recovery requires an understanding of the underlying issues, through therapy sessions.
Therapies utilised in rehabilitation programmes include:
Cognitive Therapy
Cognitive therapy teaches patients to consciously recognise exactly what thoughts, feelings, and behavioural aspects are associated with physical and psychological addiction. [10]
KEY TAKEAWAY
Cognitive behavioural interventions have among the highest level of empirical evidence for successfully treating alcohol addiction and drug use disorders. [11]
Patients can use cognitive therapy sessions in addiction recovery to improve coping skills in difficult situations which previously triggered drinking habits.
Group Therapy
Group therapy allows people to see the progress of others, and improve belief that recovery from addiction is possible. [12]
There are two approaches used in group therapy work for alcohol use disorder: (i) psychoeducational and (ii) process-oriented.
Psychoeducational group counselling sessions are led by a certified addiction professional.
The process-oriented approach can increase each individual's sense of belonging.
Individual Counselling
In individual counselling for alcohol use disorder, the patient works in private sessions with a therapist, psychologist, or counsellor.
One-on-one sessions for excessive alcohol consumption can be delivered as part of an inpatient rehabilitation programme, or on an outpatient basis.
The aim of counselling is to address the underlying causes of addictive behaviours.
One on one counselling allows the patient to talk openly about uncomfortable emotions.
Progress toward goals is monitored by the therapist. Sessions normally last 50 mins.
Twelve Step Programmes
The Twelve Step programme refers to the addicted person working through the Twelve Steps of Alcoholics Anonymous to become alcohol-free.
People can use the Twelve Step programme as part of support groups in the community, or as part of a structured alcohol rehab treatment approach in a private residential rehab clinic.
Programmes such as SMART Recovery, and Secular Organizations For Sobriety, were set up to provide the benefits of the Twelve Step programme, but without the religious overtones which some people do not appreciate.
EEG
EEG neurofeedback treatment programmes have been shown to improve abstinence rates in alcohol use disorder. [13] [14]
Mindfulness/Emotion Regulation
Mindfulness has been shown to increase self awareness and reduce the likelihood of lapse back to addiction, by slowly retraining old neural pathways over time. [15]
Mutual Aid
Mutual aid groups are non-profit organisations providing members with peer-led support.
Meetings provide social connectedness, but do not provide medical assistance or alcohol detox.
Alcoholics Anonymous
Alcoholics Anonymous (AA) is a non-professional fellowship, whose purpose is to enable attendees to stay sober via the Twelve Steps program.
Bill Wilson (1895-1971) and Robert Holbrook Smith (1879-1950) co-founded AA in 1935 in Akron, Ohio, United States.
AA has no commercial affiliations and is self-sustained through members' contributions.
AA meetings take place weekly.
SMART Recovery
SMART stands for Self Management And Recovery Training.
SMART Recovery aim to equip people with the practical tools and skills required to quit drinking and stay sober over time.
SMART Recovery run weekly meetings internationally and online training courses promoting abstinence from any addictive behaviour.
Joe Gerstein founded SMART Recovery in 1994 .
Women For Sobriety
Women for Sobriety (WFS) is an addiction recovery group specifically for women, founded by Jean Kirkpatrick in 1976.
The group recognises self-esteem as the main cause of female alcoholism, and provides a programme which addresses self-esteem issues.
Secular Organizations For Sobriety
Secular Organizations for Sobriety (SOS) (or Save Our Selves), is a network of self-governing addiction recovery groups.
SOS focuses on rational thinking and non-spiritual or religious methods of support to maintain sobriety.
SOS does not view surrender to a higher power as a pre-requisite for sobriety.
SOS does not support sponsor/sponsee relationships as part of its approach.
SOS was founded in 1985 by James Christopher.
Other Recovery Organisations
Rational Recovery
Rational Recovery sells informational products and material for overcoming alcoholism and addiction.
Rational Recovery has no religious affiliation, and considers alcoholism to be a voluntary behaviour.
Rational Recovery was founded in 1986 by Jack Trimpey, a clinical social worker.
Dual Diagnosis
Individuals diagnosed by a psychiatrist as having both a mental health disorder and alcohol use disorder, are known as having a dual diagnosis.
2018 research by Public Health England indicates that 54% of people receiving help for addiction to alcohol, also need mental health treatment. [16] [17]
Each person's combination of addiction, health complications, and mental health issues is unique, and requires individual assessment to determine an appropriate treatment programme.
Relapse Prevention
A person relapses if they re-use alcohol following treatment.
People typically view an alcoholic as either "relapsed" or "in recovery," however this binary definition is being challenged.
Researchers are increasingly redefining relapse as a spectrum, instead of binary definition. [18][19]
Social Behaviour Change
A treatment facility will normally discourage people from social contact with individuals who still consume alcohol.
Self-distancing from old social peers helps to remove the conditions which first gave rise to addiction.
In recovery, social life can continue, but usually means trying to connect with more positive influences.
Aftercare
A 2011 study suggests that regular aftercare attendance is an important factor in lower levels of drug and alcohol misuse 6 months after treatment.[20]
Data from the same study suggests that longer durations of residential treatment are associated with greater engagement levels in ongoing care.[20]
Coping Strategies
Addiction treatments help individuals change how they react to stimuli that previously triggered addictive behaviours.
In rehabilitation therapeutic sessions, patients gain insights into the events, people, places and situations which trigger addictive behaviour in their life.
During aftercare planning, clients can plan ahead to reduce the impact of trigger situations on their behaviour in future. This can help stabilise long term recovery outcomes with the right mindset.
Other Relapse Prevention Methods
Gordon Alan Marlatt (1941-2011) popularised the concept of "urge surfing" as a means to visualise cravings for alcohol as physical waves which ultimately dissipate.[21]
Dr Mary Latimer, Dr G. Alan Marlatt, and Rebekka S Palmer have proposed multiple cognitive behavioural intervention-based strategies to avoid relapse.[22]
Alternative therapies such as neuromodulation have shown promise in short term studies, but mixed results in sustaining recovery in the long term. [32]
Alcohol Home Detox
Due to risk of seizures and delirium tremens during alcohol cessation, medically unsupervised alcohol rehab in your own home is usually not recommended.
Home detox options usually consist of semi-supervised detoxification with appropriate oversight by medical professionals.
Home-based rehab usually does not include psychotherapeutic intervention or cognitive help to assist with the root cause of addiction.
Alcohol home detox may have reduced success rates since it often places the person in the same circumstances and environment that initially led to issues of addiction.
Emotional problems underlying the urge to drink alcohol are not usually addressed in a home detox.
Always speak with your GP re help for alcoholism, in the first instance.
28 Day Rehabilitation
Most private treatment clinics operate a 28 day residential alcohol rehab programme.
This is the minimum primary care term considered to provide sufficient time to complete cessation and gain therapeutic insights into the cause of alcohol problems.
Low Cost Services
Since stopping drinking alcohol safely usually requires medical supervision, low cost alcohol rehabs are in demand.
Quasi-Residential
Quasi-residential alcohol rehab centres offer a rehab programme during daylight hours, but users reside in shared accommodation overnight.
In a quasi-residential rehabilitation centre, the programme is less intensive and has less professional monitoring or oversight.
Therapeutic work is often community-led and will not include specialist staff offering cognitive behavioural work or counselling.
Local Community Addiction Teams
Local authority healthcare services run statutory alcohol rehab programmes.
Local area drug and alcohol service teams provide regular keywork sessions, encourage users to keep a drinks diary, and monitor usage over time.
Treatments For Young Adults
Most treatment centres work with adults aged 18 years and over.
NICE provides specific guidelines for alcoholism in young people.[23]
Treatments For The Elderly
Effective addiction treatment options for older adults and seniors are available at most residential rehab centres.
Inpatient alcohol rehab for seniors may be more complex due to a greater incidence of co-occurring healthcare issues.
Therefore, treating alcoholism in the elderly should be evaluated on an individual basis, to ensure the patient's needs are fully met. All pre-existing conditions and medications should be accounted for in the treatment plan.
Alcohol And Depression
A 2018 United States national survey found 31.3% of people with mental health issues had been binge drinking in the past month.[24]
Alcohol itself acts a depressant in the human nervous system.
In our experience at Abbeycare, a majority of those seeking addiction help also suffer from depression, simultaneously.
Individuals with depression can suffer low motivation and anxiety symptoms while taking part in an addiction rehab programme.
Whilst integrated treatment centres for substance abuse treatment and mental health are available in the United States, there are few in the UK.
However, in practice at Abbeycare, when clients tackle the psychological components of addiction itself, depression often alleviates also.
Recovery Help For Women
In a women-only drug and alcohol rehab centre, it is easier to work through any psychological issues normally exacerbated by other genders. In a female rehab centre, it is more likely that progress is maintained over time.
Female-only rehab clinics for alcoholism can be particularly beneficial where the person has therapeutic issues around males.
Loved Ones And Alcohol Treatment
How does alcohol use disorder affect the alcoholic's loved ones?
More than 100 million family members are affected by a relative who is addicted to alcohol.[25]
Evidence suggests that family level intervention and the right support, play a significant role in treatment outcomes.[26]
How Does Rehab Support The Family Of The Alcohol Addict?
Most people assume the addicted person is worst affected, however, addiction is a real challenge for family members.
What help is available for families affected by addiction?
Many rehab clinics hold family meetings led by addiction specialist staff to offer support and answer family members' questions.
Telephone support can also help family members to discontinue any behaviours enabling the addiction. Remote support can also help family learn how to set appropriate boundaries with the dependent person.
Fully integrative family programmes aim to improve function of the overall family unit. Family support will usually include advice on reducing circumstances and behaviours conducive to addiction.
A SAMSHA 2020 published guide instructs treatment providers and rehab clinics on how to include families in addiction treatment.[27]
Treatment Statistics
In England in 2018/2019, the average age of someone receiving help for alcohol use disorder was 46, and 60% of people in treatment were male[28].
Addiction recovery statistics from Public Health England indicate that timeframes for recovery vary according to substance type, recency, frequency, and history of addiction.
Success Rates
Rates of regression for substance use disorders (~40-60%) are similar to those for other chronic diseases such as asthma, type II diabetes, and hypertension.[29][30]
NICE Guidelines For Alcohol Use Disorders
NICE (National Institute for Health & Clinical Excellence) publish detailed guidelines for the management of alcohol use disorder.[3]
Abbeycare Programme
We can help you stop drinking. The Abbeycare residential alcohol rehabilitation programme utilises evidence based therapies, and takes a holistic approach:
Overcoming alcohol addiction is possible, with the right help, and the right rehab programme.
Going to rehab is perhaps the most important decision you'll ever make.
Our friendly team are available for advice on addiction treatment options suited to your unique needs.
Recover with Abbeycare: please call 01603 513 091 for a free addiction assessment.
Please note key elements of our drug addiction treatment and alcohol rehab programme may be altered under Covid-19 conditions.
Additional FAQs
What is the chance of relapse after alcohol rehabiliation?
The relapse rate after alcohol rehab is similar to that of other major chronic diseases.
Statistics from drugabuse.gov[30] show that incidence of relapse for addiction disorders is in the range of 40-60%, compared to hypertension and asthma, which have regression rates of 50-70%.
What is recovery from alcohol addiction?
The definition of being "in recovery" is not fixed, but usually this means the person is receiving some form of ongoing support and alcohol addiction help.
The recovery process is ongoing, in perpetuity.
Recovery from alcohol addiction acknowledges that there is no "cure", and that recovery is an ongoing practice.
People in sustainable long term recovery usually have a wide range of support channels to help maintain long-term sobriety.
What questions to ask an alcohol treatment centre?
Ask an alcohol service these questions:
The complete guide to finding the right alcohol addiction treatment, called "Finding The Right Rehab" is available under the Help & Advice menu above.
Start your recovery journey today. For an initial assessment, or to find out about treatment options available, please call us 01603 513 091.
All information is reviewed by medical professionals. Information provided is not intended to be a substitute for appropriate medical advice from your doctor. Always ask your GP's advice in the first instance when seeking treatment for alcohol addiction. For a free confidential assessment, please call us on 01603 513 091. Or, request a free callback.
[2] https://icd.who.int/en
[3] https://www.nice.org.uk/guidance/cg115/evidence/full-guideline-136423405
[4] https://lk2.app/k-3ri
[5] https://jnnp.bmj.com/content/79/8/854.short
[6] https://www.nice.org.uk/guidance/ta325/chapter/1-Guidance
[7] https://www.therecoveryvillage.com/alcohol-abuse/treatment-rehab/
[8] https://zenodo.org/record/1230663
[9] https://www.recoveryanswers.org/recovery-101/brain-in-recovery/
[10] https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-therapies/cognitive-behavioral-therapy
[11] https://doi.apa.org/doiLanding?doi=10.1037%2Fadb0000311
[12] https://www.ncbi.nlm.nih.gov/books/NBK64223/
[13] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5622970/
[14] https://journals.sagepub.com/doi/10.1177/1550059415605686
[15] https://psycnet.apa.org/record/2012-18077-001
[16] https://alcoholchange.org.uk/alcohol-facts/fact-sheets/alcohol-statistics
[17] https://www.gov.uk/government/publications/substance-misuse-treatment-for-adults-statistics-2018-to-2019/adult-substance-misuse-treatment-statistics-2018-to-2019-report
[18] https://www.unodc.org/pdf/india/publications/per_rec_tool/binder9.pdf
[19] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553654/
[20] https://www.tandfonline.com/doi/abs/10.3109/10826084.2011.572941?journalCode=isum20
[21] https://en.wikipedia.org/wiki/G._Alan_Marlatt
[22] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6760427/
[23] https://www.nice.org.uk/guidance/cg115/evidence/full-guideline-136423405, Ch 5.22
[24] https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf
[25] https://www.sciencedirect.com/science/article/abs/pii/S0277953612007988?via%3Dihub
[26] https://bmjopen.bmj.com/content/8/1/e019433#ref-12
[27] https://store.samhsa.gov/product/treatment-improvement-protocol-tip-39-substance-use-disorder-treatment-and-family-therapy/PEP20-02-02-012
[28] https://alcoholchange.org.uk/alcohol-facts/fact-sheets/alcohol-statistics
[29] https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery
[30] https://lk2.app/570vq
[31] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2670779/
[32] https://pubmed.ncbi.nlm.nih.gov/28055126/
