Alcohol Rehabilitation Counselling

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Alcohol Rehabilitation Counselling

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KEY TAKEAWAYS

Elements of alcohol rehabilitation counselling contributing most to positive long-term outcomes are:

Reframing situations through multiple perspectives
Allowing a deeper understanding of the underlying causes of addiction
Receiving direct support from the therapist assigned to the alcoholic during family sessions [1].

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How Alcohol Counselling In A Rehab Setting Generates Positive Outcomes

Group therapy - allows for the reframing of situations through multiple perspectives, peers can relate to similar experiences and offer advice alongside counsellors
Individual counselling sessions - allow a deeper understanding of the underlying causes of addiction following discussions in group therapy
Family counselling - families are given direct support by the therapist assigned to the alcoholic during treatment. Abbeycare runs a Sunday Zoom session for patients and family members
Community in the clinic - living and socialising with other patients creates bonds that lead to greater trust and openness in counselling sessions
Creating a familiar environment away from outside stressors - patients feeling safe and away from stressors makes it easier to build trust and reassure the patients of a resolution to issues than in outpatient facilities
Reduction of denial - voluntarily admitting to inpatient treatment means denial or excuses around alcoholic behaviours are more difficult

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Why These Elements Are Used In Alcohol Rehab Counselling

Group therapy - establishes a pattern or underlying beliefs of addiction by allowing the client to compare the experience of addiction with others
Individual counselling sessions - discussions for issues that have been realised in group discussions that the client is not comfortable sharing in a group setting
Family counselling - teaches families how to support the alcoholic during recovery and after leaving rehab facility
A joined-up approach to care - counselling follows the same approach consistently throughout inpatient treatment
Supervised protected environment - allows clients to explore emotions with trained counsellors

Alcohol Counselling In Rehab vs Other Environments

Outpatient Rehab

Unlike traditional rehab settings, outpatient care may re-trigger the patient via external stimuli when leaving the outpatient rehab.

As there is no guaranteed continuity of care from the same therapist in outpatient rehab, patients are unable to create a similar rapport found in inpatient client-therapist relationships

As a result, patients may be unwilling to discuss trauma or leave important discussions until the end of sessions [2].

Quasi-Residential Rehab

Unlike traditional rehab programmes, quasi-residential counselling is led by a sponsor or peer instead of a qualified counsellor, usually incorporating complementary literature such as The Big Book Of Alcoholics Anonymous.

There is no professional support available if unresolved trauma arises during a counselling session, unlike residential private care.

ADP Team

An Alcohol Drug Partnership (ADP) team partners with other local community service providers to organise counselling [3].

The typical waiting list for counselling from an ADP team is 18 months long.

Counselling is usually provided by a general therapist, who lacks the experience and understanding of addiction that is available in a residential clinic.

ADP team-provided counselling use different counsellors and self-help workbooks, that do not effectively tackle the causes of alcoholism.

Workplace Counselling

Workplace addiction counselling is subsidised or paid for by employers, making it an affordable option for therapy.

Unlike traditional rehab, workplace counselling is focused on issues occurring in and affecting the work environment.

Meaning, that if the underlying cause of alcohol addiction lies in issues outside the workplace, workplace counselling will not be an effective solution.

Private Counselling

Private counselling gives the breadth of scope to talk about issues other than addiction, such as depression or anxiety, that cannot be explored in traditional rehab settings.

Unlike residential rehabs that offer a standardised treatment plan, private counselling offers different modalities of counselling.

Residential rehab counselling is limited to the 4-week rehab programme, whereas private counselling can be as many sessions as the patient needs.

Private counselling provides therapy that works around childcare or work commitments.

Private counselling has an average cost of £100 per session, unlike residential rehab which includes all forms of therapy needed in the overall cost of the stay.

Header	Traditional Rehab	Outpatient Rehab	Quasi-Residential Rehab
Joined Up Approach	Yes	No	No
Continuous Therapeutic Care	Yes	No	No
Peer-Led Treatment	No	No	Yes
Addiction Specialist Counselling	Yes	Yes	No
Fits With Other Commitments	No	Yes	Yes

Header	ADP Team	Workplace Counselling	Private Counselling
Joined Up Approach	No	No	No
Continuous Therapeutic Care	No	No	No
Peer-Led Treatment	No	No	No
Addiction Specialist Counselling	Yes	No	No
Fits With Other Commitments	No	Yes	Yes

Short Term vs Long Term Alcohol Counselling In Rehab

Header	7-14 Day Rehab	84 Day Rehab
Processes Used	Approximately 3 days of counselling	More personalised and in-depth therapy, group and family therapy
Client Therapist Relationship	Less time to build trust	More time to build trust, understand underlying causes of addiction, triggers and previous reasons for drinking
Consistent Counselling Approach Throughout Treatment?	No cohesive approach	Cohesive approach
Efficacy Of Group Therapy	Limited time to make connections/ learn from others	New client rotations in group therapy mean insights will change and provide multiple perspectives
Time To Resolve Triggers	Time to identify triggers but not resolve them	Time for coping techniques to be practised for real-life scenarios

When Alcohol Rehab Counselling Is Appropriate

Post Detox

Alcohol counselling is most appropriate when detox has been completed as the patient must be in the right frame of mind to fully focus on alcohol addiction counselling.

Counselling is appropriate after a breakthrough where the patient realises they can no longer ignore or rationalise behaviours due to drinking.

Taking Responsibility

Those in denial about alcohol addiction are happy to assign responsibility to others, make excuses and avoid seeing the problems alcohol use is causing.

Conversely, those ready to accept responsibility for alcohol use, as well as the ramifications, are ready to undertake alcohol rehab counselling.

Prepared To Discuss Trauma

The ability to understand that trauma is an underlying cause of alcoholism is important when moving forward in recovery.

Willing To Learn From Others

Using group sessions to learn from others, helps change the meaning of events associated with alcoholism, as well as develop an understanding of triggers and causes of addiction.

Away From Triggers

Counselling in alcohol rehab is appropriate when the patient has stepped away from triggers and enablers in the outside world in an inpatient facility.

When Alcohol Rehab Counselling Is NOT Appropriate

Withdrawing From Alcohol

Attempting counselling before detox is complete is not effective, as patients are dealing with fatigue and mood changes due to withdrawal.

Mental Health Conditions Affecting Counselling

Schizophrenia, bipolar disorder and borderline personality disorder can be exacerbated by alcohol use, but it is impossible to isolate and treat symptoms of mental health disorders and alcoholism simultaneously.

Environmental Conditions Affecting Recovery

Environmental conditions that may not be appropriate for alcohol counselling include:

Living conditions with multiple triggers
Being surrounded by enablers, other alcoholics, or co-dependents
Being discharged from rehab into conditions that previously resulted in relapse

Coerced Into Rehab By Others

Those who have been coerced into rehab by friends or family may still be in denial about alcohol addiction, and unwilling to address the underlying causal issues.

Being Triggered

In group therapy, descriptions of others' trauma can lead to being triggered, causing the patient to discontinue treatment.

What Alcohol Rehabilitation Counselling Is NOT

Permanent Removal From Enablers

Although alcohol addiction treatment provides space away from the enabler, counselling does not remove the enabler, and cannot prevent attempts to return to drinking post-rehab.

Strategies for coping with enablers must instead be discussed during aftercare planning.

Curing Day-to-Day Triggers

Whilst family, peer and environmental triggers are discussed in therapy, and coping skills to use outside of rehab are practised, it is still impossible to know how an individual will react to these triggers until faced with a real-world situation.

Outpatient CBT or a sponsor gives the alcoholic a point of contact when triggers arise.

This individual is able to provide real-time advice and assistance from the perspective of lived experience.

It may take several attempts and different solutions before there is a resolution for triggers.

A Fix For Relationship Issues

Although some family members attend family therapy; relationships with friends, other family members and co-workers are not automatically fixed when returning from rehab.

It is important for those around the alcoholic to:

Reinforce positive behaviours
Set boundaries
Avoid enabling or codependency

Through our practical knowledge at Abbeycare, we inform our clients before leaving the facility that those around them may act differently as they adjust to the changes in the client.

This may require specific secondary therapy, such as marriage counselling or family counselling.

References

[1] Center for Substance Abuse Treatment. “Groups and Substance Abuse Treatment.” NIH Gov, Substance Abuse and Mental Health Services Administration (US), 2013. “Groups enable people who abuse substances to witness the recovery of others. From this inspiration, people who are addicted to substances gain hope that they, too, can maintain abstinence. Furthermore, an interpersonal process group, which is of long duration, allows a magnified witnessing of both the changes related to recovery as well as group members’ intra- and interpersonal changes.”
[2] Wittink, Marsha N., et al. “Patient Priorities and the Doorknob Phenomenon in Primary Care: Can Technology Improve Disclosure of Patient Stressors?” Patient Education and Counseling, vol. 101, no. 2, Feb. 2018, pp. 214–20. “When patients do discuss their priorities, it is often relegated to the end of the visit, when the physician asks, with their hand already on the doorknob, ‘is there anything else you wanted to discuss?’ This situation, in which the patient finally reveals the underlying concern, has been referred to as the ‘doorknob phenomenon’.”
[3] ADP Glasgow City Alcohol and Drug Partnership. "Glasgow City Alcohol and Drug Strategy - 2020-2023." 2020. “The recovery communities are key partners and influencers in the development of Recovery Oriented Systems of Care for service provision across the ADP.”

About the author

Harriet Garfoot

Harriet Garfoot BA, MA has an Undergraduate degree in Education Studies and English, and a Master's degree in English Literature, from Bishop Grosseteste University. Harriet writes on stress & mental health, and is a member of the Burney Society. Content reviewed by Laura Morris (Clinical Lead).

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Last Updated: April 6, 2026