To understand treatment and make the right treatment choices in addressing alcoholism, it helps to have an overview. Alcoholism treatment is often seen as having four general phases:
- Getting started (assessment and evaluation of disease symptoms and accompanying life problems, making treatment choices and developing a plan)
- Detoxification (stopping use)
- Active treatment (residential treatment or therapeutic communities, intensive and regular outpatient treatment, medications to help with alcohol craving and discourage alcohol use, medications to treat concurrent psychiatric illnesses, 12-step programs, other self-help and mutual-help groups)
- Maintaining sobriety and relapse prevention (outpatient treatment as needed, 12-step programs, other self-help and mutual-help groups)
First, the alcoholic must overcome denial and distorted thinking and develop the willingness to begin treatment—what Alcoholics Anonymous (AA) calls “the desire” to stop drinking. At this stage, it is important to obtain the help of someone knowledgeable about treatment and the options available.
When getting started, some people have lost control over alcohol to such an extent that they will only be able to make immediate decisions and set the most basic goal of quitting drinking. Development of a detailed treatment plan with goals and choices may have to wait until after detoxification.
On the other hand, “getting started” is exactly the place where some people with alcohol problems “get stuck.” In being stuck, denial is always a problem, but complete denial is not universal; people have various levels of awareness of their alcohol use problems, which means they are in different stages of readiness to change their drinking behavior. Professionals have taken advantage of this insight about alcoholism to develop treatment approaches that are matched to a person’s readiness to change.
The second phase of treatment is stopping use, which can be done on either an inpatient or outpatient basis. Medical evaluation and treatment are particularly important at this stage. A large proportion of alcoholics develop dangerous withdrawal symptoms that must be medically managed either in a hospital or on an outpatient basis.
Although detoxification is a critical step for many alcoholics, most treatment professionals are reluctant to call it treatment, and for good reason. Treatment is what helps a person develop a commitment to change, keep the motivation to change, create a realistic plan to change and put the plan in action. Successful treatment means a person begins to experience the rewards of seeing the plan work. Just taking away the alcohol does not automatically produce any of these outcomes.
Relapse to alcohol addiction is most likely to occur in the first three to six months after a person stops drinking, a period characterized by physiological abnormalities, mood changes and complaints of anxiety, depression, insomnia and hormone and sleep problems. Getting active help and support during the early months of sobriety is critical for treatment to succeed.
In the third phase of treatment, a person typically gains the motivation necessary to maintain a commitment to sobriety, the knowledge and skills necessary to stay sober, and the support systems necessary to cope with the problems of daily life—the problems that everyone has to face—without resorting to the old “solution” of drinking. This is where the help of a treatment professional is important. A professional will help you better understand how alcohol has affected your health and your life, so that you can set goals and develop a plan to stay sober and choose the treatments that are right for you.
Some proven medications are available to help with alcohol craving and discourage alcohol use. A treatment professional will also help you choose medications and treatments for concurrent psychiatric illnesses, like depression or anxiety, if that is appropriate, or for a variety of health problems that often accompany alcoholism.
Research has shown that the longer people stay in treatment—that is, the longer they remain sober and actively committed to sobriety—the more likely it is that they will maintain sobriety. Some treatment professionals think of the phase of active treatment as lasting from six months to a year. During the first critical months of treatment, people often need a variety of supports, especially AA or other self-help groups, to achieve and maintain lasting sobriety.
It is often difficult to pinpoint when the active treatment phase ends and a person enters the maintenance phase of recovery. In the active stage of treatment, people learn what they need to do to stay sober and develop the many skills they will use to avoid relapse. A person could be said to enter the maintenance stage when he or she is comfortable with these skills and has had a chance to rely on them to stay sober when life throws them the inevitable curveballs, both in crisis situations and in everyday problem situations.
Many people in recovery attribute their ongoing sobriety to participation in a support group such as AA or Women for Sobriety.