When a person stops drinking heavily, their body will experience withdrawal symptoms. This relatively short period of time is known as detoxification, or ‘detox.’
Symptoms of alcohol withdrawal range in severity from person to person and not everyone will experience every symptom listed. These symptoms include: shaking, sweating, headache, nausea or vomiting, anxiety, diarrhea and stomach cramps, elevated heart rate and blood pressure, and trouble sleeping. Alcohol withdrawal can become life-threatening in some cases. Call 911 or go to the emergency room if any of the following occur: severe vomiting, confusion or disorientation, fever, hallucinations, extreme agitation, seizures or convulsions.
These severe symptoms could indicate a serious form of alcohol withdrawal called delirium tremens, or DT, which can be fatal.
People who only experience mild symptoms of withdrawal can usually complete the detoxification period without medical supervision, in two to five days. Those with more pronounced symptoms may wish to withdraw from alcohol under medical supervision, with or without medications to ease symptoms.
Whether or not detoxification is necessary depends on a number of factors, including an individual’s medical status, age and history of alcohol use. For example, someone who binge drinks and seeks treatment a week after last using alcohol may not require detox in order to begin other treatments for alcohol addiction.
People undergoing inpatient clinical treatment are in residence at a treatment facility for varying lengths of time—usually from several weeks to 30, 60 or 90 days, but sometimes for as long as 6 months—and have access to care around the clock. Follow-up visits are sometimes required.
Inpatient rehabilitation is recommended for people with long-term addiction, symptoms of moderate to severe withdrawal, addiction to multiple substances, co-occurring behavioral health conditions, or a history of treatment and relapse. Inpatient treatment tends to be costly because it includes lodging, meals and activities in addition to therapy.
Inpatient care typically begins with medically-supervised detoxification, followed by an intensive period of therapy that may include counseling, medication, group therapy and/ or mutual support group meetings, and wellness activities.
After an inpatient care experience, many find that their chances of long-term sobriety are increased by follow-up care in the form of a relapse prevention program or time in a sober living community.
Outpatient treatment is the least intensive level of clinical care, and is conducted on a part-time basis while the patient continues to live at home and attend work or school. This level of treatment can be appropriate for those with mild to moderate symptoms of alcohol use disorder.
Treatment typically includes many of the same elements as intensive outpatient treatment, but on a reduced schedule. Outpatient treatment can be offered in a doctor or psychologist’s office, a community clinic, or in a dedicated addiction care center equipped for outpatient treatment.
Intensive outpatient programs (IOP) are structured similarly to inpatient programs, but are typically part-time and lack a residential component. IOP’s allow patients to live at home and attend work or school while receiving intensive addiction services. An IOP can be used as a primary form of care, as follow-up to successful detox, or as part of aftercare for someone who has completed an inpatient program.
Intensive outpatient programs vary in length and range between twelve to sixteen weeks, with most people attending 3-5 times per week. IOP’s are more comprehensive than traditional outpatient programs, and generally require 10-12 hours a week of group and individual treatment and counseling. One of the benefits of IOP treatment is that it can be tailored to the individual so they can attend treatment when it works best for them. IOP’s, also called intensive outpatient treatment (IOT), offer programs during day and evening hours to accommodate family, life, and work needs.
In general, IOP’s are less expensive than inpatient recovery programs. Cost varies based on insurance coverage and length of program participation. IOP programs vary slightly depending on each treatment center, but most offer similar services and treatment options. The Substance Abuse and Mental Health Services Administration (SAMHSA) has laid out a set of core services essential to all intensive outpatient treatments, which include:
Once you have identified some potential treatment providers, it is important to ask questions to find the best facility for your needs. Below are some key points to consider when looking for addiction treatment:
Is the facility accredited or licensed? Licensed and accredited facilities are regulated and periodically reviewed. National accrediting agencies, such as The Joint Commission and the National Committee for Quality Assurance, give a stamp of approval to treatment centers that meet high standards of care. Client care, affordability and success rate are among the factors considered by accrediting agencies in evaluating providers.
How will treatment be tailored to your needs? Treatment should address all health needs of the individual, not just their drug or alcohol abuse. Effective treatment will include addressing any associated medical, psychological, social, vocational or legal issues. Ideally, treatment should also be appropriate to the individual’s age, gender, ethnicity and culture.
Does the facility have the capability to diagnose and treat co-occurring disorders? Dual diagnosis is not uncommon in individuals with substance use disorders. If there are co-occurring disorders (such as depression, anxiety or bipolar disorder), is the facility able to diagnose and treat them and their underlying symptoms? Is there a psychiatrist on staff?
What specific evidence-based addiction treatments, including medications and therapies, does the provider offer? Effective substance abuse treatments can include behavioral therapy, medications, or, ideally, their combination.
Does the program include medical detoxification (“detox”) if necessary? A medically supervised detox may be necessary to ensure that the individual is stable prior to further treatment.
Does the provider offer couples/family therapy? Support from family members can help an individual start and stay in treatment. For adolescents in particular, the use of family-based therapies can improve outcomes.
What does a typical day look like? How much of the day consists of therapy? Meetings? Other? How much individual therapeutic attention is given to each person?
What is the facility environment like? Is the facility clean and appealing? Are rooms shared with a roommate? Are there rules about phone use and visits? Does the facility promote respect and dignity and provide an environment where individuals feel safe and can focus on their treatment?
How is relapse handled? Confirm that relapsing does not mean automatic expulsion from the program. Research indicates that a minimum of three months of treatment is necessary to stop or reduce substance abuse. Relapsing is an indication that treatment should be adjusted. Programs should include strategies to engage and keep patients in treatment.
Will the provider supervise your continuing care after treatment? Aftercare is an essential part of recovery. A good program will help the individual determine what care may be needed after the initial treatment program, and how to obtain it.
Does the facility work with insurance companies? Many programs accept insurance but some do not. It is important to have all costs explained to you and to find out how the facility handles insurance and discuss your particular coverage. Do you need pre-authorization from your insurance company? Does the treatment center offer payment plans or scholarships? Remember that it is your responsibility to fully understand your insurance. You can find out which providers are in network and what is specifically covered by directly calling your insurance carrier.
Have there been any clinical practice lawsuits filed against the organization in the last three years? While lawsuits are not necessarily an indicator of negligence, they may provide information about the culture of the organization and the way others have experienced the organization.
Is the facility transparent in its operations? You should be able to get concrete answers to any questions you have, including the cost of treatment, and answers to specific questions such as the ones listed above.