To understand treatment and make the right treatment choices, it helps to have an overview. 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.