What is Alcohol Rehab Like? What to Expect

Author: Jessica Payne, LMSW, CAADC

Deciding to seek treatment for your alcohol misuse can be hard. But what is alcohol rehab like? Alcohol rehab was developed to help individuals learn skills to stop their alcohol use and avoid relapse once they leave. Over 14.5 million people have alcohol use disorder. Of those, 7.2% or approximately 1 million people receive treatment.¹ Learning what to expect at alcohol rehab can clarify any misgivings you may have. You may also gain the comfort and encouragement you need to seek treatment services.

In this article:

What is the Intake Process Like?

The intake process begins with an assessment. During the assessment, the rehab center will ask you questions regarding your alcohol use as well as other characteristics. This assessment also evaluates your medical needs and your potential for serious withdrawal. An assessment will include:^2,3

A clinical interview
Alcohol Use Disorder Identification Test (AUDIT)
Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)

The clinical interview will collect your:

Demographic information
Cultural and religious affiliations
Developmental and educational history
Medical and psychological history
Trauma history
Family history of medical, psychological, and substance misuse
Legal history
Substance use history

The Alcohol Use Disorder Identification Test (AUDIT) will dive deeper into your alcohol use. This will include questions regarding:²

The frequency of alcohol use
The amount of alcohol use
The length of time you have used alcohol

The Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar), will examine your current level of withdrawal.³ The CIWA-Ar will likely be repeated throughout the time you are in rehab to ensure your symptoms are well managed. Specific symptoms measured on this tool are:

Anxiety and agitation
Auditory and visual hallucinations
Headache
Nausea and vomiting
Sweating
Tremors

Various rehab centers and clinics will have their own established rules and guidelines that you must adhere to. However, every facility will prohibit alcohol, other drugs, and related paraphernalia at the location. This is intended to maintain a safe, conducive atmosphere for treatment.⁴

Detox Services

If these assessments reveal that you need detoxification, you will encounter that phase of treatment first. Detox services give you the ability to wean your body from alcohol dependence with minimal harm caused by withdrawal symptoms. Such symptoms can appear as early as six hours after your last use of alcohol. The most severe symptoms of withdrawal can appear as late as 72 hours after ceasing alcohol use.⁵

Your provider will monitor your symptoms continually to identify if you are at risk of severe withdrawal. Typically, detox services include medication management to lessen the potentially harmful effects of alcohol withdrawal. With that in mind, medications that can be prescribed during alcohol detox services and shortly thereafter are:^4,5,6

Adrenergic medications
Anticonvulsants
Antipsychotics
Baclofen
Benzodiazepines
Over-the-counter (OTC) medications
Relapse prevention medications (e.g., Naltrexone and acamprosate)

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Benzodiazepines

Existing research thus far has shown benzodiazepines have the largest amount of evidence for effectiveness in treating alcohol withdrawal.⁵ Due to this, benzodiazepines tend to be the preferred medication for withdrawal symptoms. Some common benzodiazepines are:⁴

Diazepam
Chlordiazepoxide
Lorazepam

Adrenergic Medications

Adrenergic medications can help with physical symptoms of withdrawal, such as elevated pulse and high blood pressure.⁵ Common adrenergic medications are:

Clonidine
Propanol

Anticonvulsants

Anticonvulsants can be a suitable alternative to benzodiazepines.⁵ Using an anticonvulsant reduces the probability that you will experience a seizure. Anticonvulsants also can help reduce cravings. Common anticonvulsants include:

Gabapentin
Valproic acid

Antipsychotics

Antipsychotics have been used for a long time to assist with alcohol detox.⁵ Antipsychotics can be helpful in the treatment of agitation and hallucinations and help relieve you of any delusions or delirium that occurs. Some antipsychotics can lower the threshold of seizures and are therefore avoided. A common antipsychotic that could be used is haloperidol (Haldol).⁵

Baclofen

Baclofen is a newly studied medication for alcohol withdrawal. Preliminary research has shown it can be helpful in the relief of severe withdrawal symptoms, and helpful in reducing cravings.⁵

Over-the-Counter Medications

Medications that can assist the detoxification process also include over-the-counter anti-diarrhea and anti-nausea medications. Pain medications, such as acetaminophen, also can help manage symptoms of withdrawal but are cautioned against in those who have liver disease. Acetaminophen can raise levels of serum GGT, which can harm the liver, and may negatively interact with alcohol, even in low doses.⁴

Relapse Prevention Medications

There are many medications that you may be prescribed during the late stages of detox.⁵ Notably, these medications are not effective during active detox, but there can be a benefit in using these medications at the end of the detox. Especially for those individuals who leave treatment prematurely, these medications can help reduce the probability of the reoccurrence of alcohol use. Common relapse prevention medications include:⁵

Naltrexone
Acamprosate

Treatment Plan and Program: What is Alcohol Rehab Like?

Shortly after you have completed the intake process and begun your detox services, your care team will begin to plan your treatment with you. Usually, your treatment team is composed of various professionals trained to provide treatment services to individuals struggling with alcoholism. This team may consist of:

Physicians
Psychiatrists
Psychologists
Nurses
Nutritionists
Social workers/professional counselors
Support staff (e.g., medical assistants, case managers)

You will set goals and address how you will accomplish these goals with the help of your treatment team. This treatment plan can include goals specific to your alcohol use as well as any other goals for improved functioning.

Your treatment plan can include improving relationships, communication, or even improving your mood and decreasing anxiety. It is also common for individuals to identify goals of employment or resolve legal issues.

Being more engaged in your treatment plan and program makes it likelier that you will accomplish your goals. Thus, the chances of a positive outcome for your rehab experience increase.⁷

Therapies Used in Alcohol Rehab

Your treatment in rehab likely will include individual and group therapy and maybe family therapy. Behavioral therapies are a common choice of rehab facilities. These types of therapies are designed to help you:⁷

Learn strategies and coping skills to deal with cravings and avoid relapse
Improve communication
Improve relationships
Improve parenting skills
Improve ability to manage and self-regulate emotions

Therapy during rehab will help you identify your attitudes, feelings, beliefs, and behaviors that have become associated with your alcohol use. Learning to identify these can help you gain general life skills. Thus far, several behavioral therapies have demonstrated effectiveness in treating alcoholism, which include:⁷

Cognitive-behavioral therapy (CBT): CBT addresses behavioral patterns and processes with short-term treatment goals achieved in group collaboration.
Contingency management (CM) interventions/motivational incentives: CM reinforces abstinence and other positive behaviors by offering tangible rewards to patients.
Community reinforcement approach (CRA) plus vouchers: CRA is used to treat persons addicted to cocaine or alcohol. A variety of reinforcers and material incentives are used in a 24-week intensive outpatient setting. This method attempts to make sobriety more rewarding or appealing than substance misuse.
Motivational enhancement therapy (MET): MET involves quick changes spurred by internal motivators to help patients promptly overcome alcohol use. Counseling encourages patients to seek treatment.
12-Step facilitation therapy: A 12-step program promotes abstinence through self-help groups that methodically engage a user to abandon their substance use.
Family behavior therapy: A partner, parent, or other significant relation is brought in to develop solutions to co-occurring problems, such as depression, alongside alcohol use.

How Long Does Alcohol Rehab Last?

Alcohol rehab can vary in length. Short-term rehab is likely to be between 3 and 6 weeks.⁷ Long-term rehab can be anywhere between 6 and 12 months.

Alcohol rehab can also be confused with alcohol detox. Although alcohol rehab will begin with alcohol detox services, rehab will then transition into treatment, whereas alcohol detox will discharge you into aftercare. Alcohol detox services often last a few days to a little more than a week.

A Sample Schedule of What to Expect at Alcohol Rehab

Alcohol rehab can be a highly structured environment. Depending on your facility, you may share a room with others and may have to participate in communal living responsibilities. However, there will be opportunity for downtime when you can choose to engage in self-care or amenities your facility offers. Not all rehab facilities are the same; however, this is an example schedule to learn what is alcohol rehab like:

8 a.m.: Wake up, get ready, have breakfast, and do chores
9 a.m.: Skills group therapy
11 a.m.: Individual therapy
12 p.m.: Lunch
1 p.m.: Peer-support group meeting
2 p.m.: Free time (e.g., meditation, exercise, call non-using friends/family)
3 p.m.: Process group therapy
5 p.m.: Dinner
6 p.m.: Peer-support group meeting
7 p.m.: Free time
9 p.m.: Chores and prepare for bed
10 p.m.: Bedtime

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Aftercare Planning

Aftercare planning is an essential part of your treatment. Once rehab has been completed, your treatment does not stop. Aftercare planning is what comes after rehab. Aftercare is care that:

Supports your progress and monitors your condition
Has the ability to respond should you experience a relapse or mental health crisis
Is treatment on its own and a supplemental form of treatment

Aftercare planning can include peer support groups, intensive or standard outpatient services, and sober living housing. Before your discharge from rehab, your treatment team will discuss their recommendations of aftercare and community services near you.

General recommendations for aftercare include:⁸

Services for no less than 3 months after discharge from rehab
Follow-up check-ins from your rehab center for at least 12 months
Involvement in mutual-support groups and community-based support programs
Meet your unique needs

How to Find an Alcohol Rehab Program

Getting help for your alcohol use can be a scary and difficult decision to make, but one you will not regret. You can start by asking an existing medical and behavioral health provider what to expect at alcohol rehab. If you are not connected with one or do not feel comfortable asking them, please call 800-963-1579 (Who Answers?) . Our specialists can help locate services to fit your needs.

Resources

National Institute on Alcohol Abuse and Alcoholism. (2021). Alcohol Use in the United States.
Saunders, J. B., Aasland, O. G., Babor, T. F., de la Fuente, J. R., & Grant, M. (1993). Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption–II. Addiction, 88, 791–804.
Sullivan, J. T., Sykora, K., Schneiderman, J., Naranjo, C. A., & Sellers, E. M. (1989). Assessment of alcohol withdrawal: The revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar). British Journal of Addiction, 84(11), 1353-1357.
Substance Abuse and Mental Health Services Administration. (2015). Detoxification and substance abuse treatment.
Sachdeva, A., Choudhary, M., & Chandra, M. (2015). Alcohol withdrawal syndrome: Benzodiazepines and beyond. Journal of Clinical and Diagnostic Research, 9(9), VE01–VE07.
Bergeron-Parent, C. (2020). Alcohol withdrawal in my office…Yes! Family Doctor: A Journal of the New York State Academy of Family Physicians, 8(3), 52–55.
National Institute on Drug Abuse. (2020). Principles of drug addiction treatment: A research-based guide (Third edition)
Substance Abuse and Mental Health Services Administration. (2020). Substance use disorder treatment for people with co-occurring disorders.