How Do the Alcoholism Treatment Stages Work?

When you enter treatment for alcohol use disorder (AUD), it is important to understand the recommended stages of treatment. The National Institute on Drug Abuse (NIDA) recommends that anyone seeking addiction treatment remain in the program for at least 90 days, or three months, to change behaviors around drugs or alcohol. It is also important for treatment programs to focus on effective treatment based on evidence, so there are specific stages that rehabilitation programs should offer.

Start with Detox from Alcohol Dependence

Alcohol abuse can lead to serious withdrawal symptoms that require medication management. Symptoms of alcohol withdrawal may include:

• Anxiety
• Nausea, vomiting, or stomach upset
• Physical tremors
• Headache
• Increased heart rate
• Sweating
• Irritability
• Confusion and other mental state changes
• Insomnia
• Nightmares and other sleep disturbances
• High blood pressure

In some cases, alcohol withdrawal syndrome (AWS) can develop into delirium tremens, a life-threatening physical condition that may include symptoms like:

• Severe confusion or delirium
• Body tremors
• Extreme agitation
• Overexcitement, fear, or paranoia
• Hallucinations
• Random bursts of intense energy
• Rapid mood changes
• Sensitivity to light, touch, sound, etc.
• Stupor
• Sleeplessness, including insomnia
• Loss of appetite
• Chest pain
• Stomach pain
• Fever
• Seizures

Delirium tremens is more likely to occur in people who have repeatedly tried to end alcohol abuse but experienced relapses and in people who commonly drink four to five pints of wine, seven or eight pints of beer, or one pint of liquor every day for several months. Additionally, people who have abused alcohol heavily for a decade or more are at very high risk of delirium tremens. This condition highlights the need for medical oversight to safely detox from alcohol abuse, making this first step one of the most important parts of alcoholism treatment.

Getting treatment for alcohol withdrawal starts with being assessed by a physician. Withdrawal symptoms may be mild, so they may not require prescription medicines. If they are severe, you may receive a prescription for a benzodiazepine to help you taper off physical dependence on alcohol.

Alcohol Treatment Programs to Change Behaviors

After safely detoxing from alcohol, so your body is no longer physically dependent on the substance, it is important to enter a rehabilitation program that is specific to alcohol use disorder. This may either be an inpatient or outpatient program, meaning you may live on the premises where the program is administered, or you may go to a hospital, therapist, or outpatient center for therapy sessions. The American Society of Addiction Medicine (ASAM) lists several stages on their Continuum of Treatment, depending on the needed level of care.

• Residential inpatient treatment: This type of program involves 24-hour medical monitoring and provides intensive pharmacological or therapeutic treatment. Typically, people who need this level of supervision stay for 3-6 months. Some programs allow residents to get treatment for a year or more while others only provide residential treatment for a month or two, though these may be followed by outpatient treatment and mutual support groups.
• Intensive outpatient treatment: Although the individual may live at home while attending this type of outpatient program, they typically attend therapy sessions for four or five days a week for several hours. The number of therapy sessions provided in intensive outpatient treatment are more like those in inpatient programs. These programs may include individual therapy and prescription medication as well.
• Standard outpatient treatment: Those who have not abused drugs for a long time or at high doses may be able to safely live at home and go to work while also attending an outpatient program for fewer than 10 hours per week. These are usually group therapy sessions although some may also include individual therapy sessions.

Work with a therapist or physician to be referred to the right type of rehabilitation program, based on your withdrawal experience and history of AUD. Once you have completed rehabilitation, you do not simply stop your recovery process – maintaining social support or therapy sessions, and possibly taking some prescription medications, will help you stay focused on sobriety and your long-term health.

Alcohol Detox Maintenance Drugs

After safely detoxing from alcohol abuse, it is rare to continue taking prescription drugs; however, if you have struggled with relapse in the past, you may receive a maintenance medication. The prescriptions used to reduce cravings include:

• Acamprosate: This medication may reduce withdrawal symptoms, especially psychological issues like anxiety and cravings. Reducing the mental discomfort from stopping alcohol abuse can help you maintain abstinence.
• Disulfiram: This older drug interferes with how alcohol is broken down by the liver, so if you do lapse or relapse and begin drinking, you will feel very sick rather than intoxicated. It is intended to teach the person taking disulfiram that there are no pleasurable benefits from drinking, but the side effects, including rapid heartbeat and vomiting, can be dangerous for some people.
• Naltrexone: This drug is also prescribed for long-term prevention of opioid abuse because it blocks the opioid receptors. It effectively reduces cravings in many people, both for alcohol and opioid abuse.

These maintenance drugs can be important for some people. In addition, ongoing social support during the recovery process has been shown to be one of the most important aspects of aftercare.

Aftercare Includes Therapy and Social Support

Mutual support groups and individual therapy help to keep you focused on recovery. Individual drug counseling for lapses or worries about lapses can help you when you feel intensely stressed or are experiencing very intense cravings. Mutual support groups can help you talk through ongoing struggles and learn how others in a similar situation deal with their stress. These forms of social support are also important for those who struggle with co-occurring disorders like depression or anxiety because symptoms associated with these mental conditions can increase the risk of substance abuse like AUD as a form of self-medication.

Other considerations in recovery include:

• Recovery-Oriented Systems of Care (ROSC): recovery or transitional housing, long-term outpatient care, and management of chronic health problems like liver or heart damage
• Recovery Support Services (RSS): community services that provide emotional support and practical help to stay abstinent
• Social and Recreational Recovery Infrastructures and Social Media: community programs and services that provide sober social activities to make new friends and find ways of socializing without drugs or alcohol present

Recovery from Alcohol Abuse Is Possible

The Substance Abuse and Mental Health Services Administration (SAMHSA) states that recovery is not a linear process. People who struggle with addiction to alcohol or drugs may experience relapse, which is a normal part of managing a chronic illness. Recovery involves many pathways to staying happy and healthy, needs the support of friends and family, and should be respectful of cultural or religious considerations. Assessing the long-term recovery plan will ensure that your treatment continues to suit your needs and includes a relapse plan. Getting treatment to manage recurring symptoms is part of the process, and countless people get the help they need through evidence-based programs and live healthy, sober lives.