Alcoholism Treatment Types: Detox, Residential, Outpatient & Counseling
Different ideas for alcoholism treatment have existed for millennia, everything from electroshock therapy to bloodletting, from lobotomies to exorcisms. Fortunately, modern types of treatment are more based in science, evidence, and research, and offer patients and their loved ones holistic and long-term plans to overcome the temptation and damage of alcoholism.
For many people, the journey of alcoholism treatment starts with an intervention, a carefully planned and controlled process where people in the affected individual’s life, who have suffered as a result of the alcoholism, present their loved one with a well-defined, timely, and achievable opportunity to seek professional help for problematic drinking. An intervention is a demonstration of love and support for the person, but it comes with a warning: If the opportunity is spurned or abandoned, then consequences will be meted out, usually in the form of eviction, job loss, divorce, revocation of custody or visitation rights, etc.
Mayo Clinic explains that the idea is to present the seriousness of not only the drinking problem, but also the undeniable harmful effects it has on friends and family.
Interventions can be tense and emotional meetings, which is why they should be moderated by a professional interventionist. This professional will work with five or six friends and family members of the individual for weeks before the actual information, coordinating all of their anger and disappointment at the alcoholism into a positive, healthy goal for everyone involved. This is usually done in the form of writing a letter to the loved one, explaining how the drinking has harmed them or their relationships, and then reading that letter out loud at the intervention.
Denial is a core symptom of addiction, says Psych Central, and simply confronting the person with accusations provides an easy way for the actual problem to be deferred or avoided; at worst, unplanned interventions can be “dangerous and counterproductive.” Presenting a unified front is a big component in what makes an intervention successful: convincing the person to stop drinking and submit to treatment. This will require research and consultation with the intervention professional to find the right kind of treatment program for the individual.
One of the key steps in the process of alcoholism treatment is medical detox, a prolonged period of time without any alcohol consumption. For people who do not struggle with a physical need for alcohol, this may not seem like a problem, but for those who have been drinking for so long that their bodies have become hooked on consuming increasing amounts of liquor just to feel normal, medical detox is meant to break them of that dependency.
At first, says Mayo Clinic, detox feels like a hangover. The person has headaches, nausea, fatigue, muscle pain and cramping, and the usual sensitivity to light and sound. There will be no alcohol on hand to alleviate these symptoms, but the doctors and nurses of a treatment center will be there to administer medication to counter the worst of these effects, and offer verbal support and encouragement for the rest of the process.
For an alcoholic, going more than 10 hours without a drink will lead to physical effects beyond merely a bad hangover. There will be high blood pressure, episodes of anxiety and depression, insomnia, and a rapid heartbeat. These are the results of many of the body’s systems struggling to find balance without the constant flow of alcohol that they have become accustomed to. The more severe the alcoholism, the greater (and rarer) the other effects of detox: hallucinations, seizures, or even psychosis.
Depending on the scope of the alcoholism, it could take a week or more for the person to fully break their physical dependence on liquor (that is, going extended periods of time will not lead to the withdrawal effects mentioned above). At this point, the person usually starts therapy to address the psychological damage done by the alcoholism. This entails counseling sessions to help the person understand the psychology of addiction and how to cope with the temptations of drinking.
Intensive Outpatient Programs
Usually, this alcoholism treatment process can last for upwards of a few months, but alternatives exist for those whose needs don’t fit the standard formula. Intensive outpatient programs and partial hospitalization programs exist for those who have finished the inpatient (residential) leg of their treatment or who require outpatient treatment (for example, if their alcoholism was not a severe problem, but they still need assistance in managing the condition).
While typical residential programs are over a month, those who fit the criteria for specialized outpatient programs have the freedom to go home after checking in for the day’s treatment, although the treatment itself can cover a full day’s worth of meetings, sessions, and classes. Similarly, a person may have to check in multiple times a week, including weekends.
If the doctor or therapist overseeing the person’s recovery believes they do not require medical detox, an intensive outpatient program (IOP) can be recommended on the basis of a clinical assessment. An IOP is a part-time regimen, but with very strict guidelines that allow clients to accommodate work and daily life routines and responsibilities into their recovery. A therapist will work with the client and their family to identify short-term goals (two weeks) for the client to meet; failure to meet those goals, such as keeping up with scheduled therapy sessions, completing homework assignments, etc., might result in admission to a more standard inpatient program.
According to the American Society of Addiction Medicine, an intensive outpatient program should give clients around nine hours of treatment every week. Regular assessments will determine if more or fewer hours should be allocated, based on how the client responds to treatment guidelines.
Partial Hospitalization Programs
An alternative to an intensive outpatient program is a partial hospitalization program (PHP), which is meant for clients who do not need the security of an inpatient setting, but understand that they still have work to do on their recovery. Such programs were originally designed for those seeking mental health therapy only, but a number of treatment centers offer them to clients needing addiction treatment. The foundations of PHPs are seen in how most of them focus on clients who present with both alcoholism (or some other form of substance use disorder) and another mental health condition (such as clinical depression or anxiety).
PHPs generally entail six hours of treatment a day for five days a week. Clients normally enter a PHP program immediately upon completing a regimen of medical detox and their inpatient treatment program (if one was needed). Much like an intensive outpatient program, partial hospitalization programs require clients to be diligent with their treatment structures, but PHPs tend to require more of a daily commitment than IOPs do. Partial hospitalization programs also require much more supervision, such as observation of medication consumption and of any symptoms of a mental health imbalance. For this reason, PHPs are sometimes known as “day treatment,” because clients receive comprehensive care while they are in the treatment center, but then are allowed to return home for the night.
Lots of people find the help they need with partial hospitalization programs. Around 35 percent of the members of the National Association of Psychiatric Health Systems offer PHPs as part of their services, saying they are a “critical” component of alcoholism treatment.
For those who do require inpatient residential treatment, the focus of the facilities is often to provide as much privacy, security, and comfort as possible. Treatment is staggered in blocks of 30 days, with a minimum period of 30 days and a maximum of 90. Generally, the longer treatment schedules are for clients who have more severe struggles with alcoholism, but they are available for any person who wants to receive the full treatment experience or who are still unsure about starting their new life outside the treatment facility.
Upon admission to an inpatient facility, doctors and therapists will conduct a medical and psychological evaluation, which requires the client to be honest about their alcoholism, how it started, how long it has been in effect, family history of mental health or substance abuse, problems at home or at work, etc. It is this information that will determine the nature of the treatment program (even down to the meals that clients are served) and how long that program will last. It might even influence the choice of anti-anxiety and anticonvulsant drugs that are administered during the detox process, since doctors will have to ensure that whatever medication they prescribe to ease the process does not clash with any other substances (besides alcohol) that the client has in their system.
Inpatient residential programs make therapy the backbone of their services. This covers individual counseling, group therapy, and sessions with family members, and it is one of the most important components of alcoholism treatment. Through therapy, a client will learn how drinking became a mental health problem, and that understanding will be used to turn negative thoughts and impulses into positive and healthy ways of coping. Making family members part of this process will go a long way in ensuring the home environment is similarly conducive to recovery, and it will address the problems in communication and relationships that may have contributed to the development of the alcoholism.
Support Groups and Sober Homes
When formal treatment has been completed, it is vital that the lessons learned during the experience are constantly applied and reinforced in the real world. For this reason, clients are encouraged to surround themselves with people who can offer round-the-clock support. This should start with family, but it also extends to others who understand the nature of alcoholism and the difficulties of sobriety. Many clients get this from a support group, like Alcoholics Anonymous or a similar 12-Step program, where members share success stories and are honest about their stumbles. Having a safety net and accountability network is a very important part of alcoholism recovery, greatly increasing the chances of living a happy and productive sober life, and offering immediate and on-the-spot damage control when things go wrong.
Another element of aftercare in alcoholism recovery is sober living homes, which are group homes for people who are holding down jobs and re-engaging with the world outside of a treatment center, but still need some help and guidance in doing so. Living in a sober home entails strictly following rules regarding sobriety, quiet hours, housework, employment, and checking in with support group sessions. Sobriety is obviously key, and submitting to random drug tests is often a condition of room and board. Repeatedly failing tests, or evidence that the person is trying to cheat the test (using old urine samples, for example), could be grounds for eviction. Lesser penalties could involve paying fines for various infractions.
As important as these conditions are for the individual, maintaining them helps the other people in the house as well, creating a home environment of discipline and structure.
Sober living homes tend to be privately owned (leading to questions about how well they are regulated), but homes that are owned by charity organizations have more transparent management.
For many people, sober living homes serve as transition zones between a residential treatment center and individuals living on their own. There is a high bar of responsibility that comes with living in a sober home, and not everyone is ready for it. However, it is something to work toward; people who live in sober living homes have to pay their own rent and buy their own food, and that sense of authority and function has its own role to play in recovery.
Rehabilitation centers offer a more quiet, secluded recovery experience, and they don’t usually allow residents the freedom of having a job or spending time outside the center. Residents at a sober living home can come and go as they please as long as they return by a certain time, and they can account for their whereabouts while they’re out of the house.