What to Expect at an Alcohol Rehab

Alcohol dependency is a big problem in the UK, with around 600,000 adults needing specialist treatment every year, according to government statistics. ^[1]

For those going to alcohol rehab for the first time, it can seem quite daunting. Many people have no idea what to expect.

In this post, we go through the important information about inpatient alcohol rehab, including the rehab process, types of therapy you can access in alcohol rehab, what a typical day in rehab looks like, and some frequently asked questions.

Why should you consider inpatient rehab?

If you have an alcohol use disorder (AUD), and you want to stop drinking, then it is crucial that you get the right help.

Not everyone knows this, but trying to stop drinking on your own can be very dangerous. Alcohol withdrawal can lead to seizures, among other serious withdrawal symptoms. Trying to detoxify at home could put your health at risk.

To ensure that your detox is as comfortable and safe as possible, you should think about inpatient rehab. Inpatient rehab allows you to detox with the help of experienced medical professionals. They will look after you and help you to manage withdrawal symptoms.

Withdrawal symptoms usually set in around 6 to 8 hours after your last drink. The length and severity of withdrawal will be determined by how dependent on alcohol you were, but for most, withdrawal symptoms last for between 24 and 72 hours.

The inpatient alcohol rehab process

In this section, we go through the inpatient rehab process from start to finish.

What happens during the admissions stage?

The first step is to seek help. The rehab process often begins with a phone consultation, in which you will speak to a trained professional who can answer your questions and make some impartial recommendations based on your situation.

During this consultation, you may be asked:

What is your history with substances?
Would you prefer inpatient or outpatient rehab?
Roughly how much are you willing to spend?
How far are you willing to travel?
How long do you want to spend in rehab?
Would you prefer just a detox or a full detox combined with rehab?

It might be a good idea to think about your answers to these questions before you pick up the phone.

After the phone call, once you have decided on the type of rehab treatment that best suits your needs, you have the option to go and visit a few inpatient rehabs to see what they are like. Rehab staff are always very welcoming and will be happy to show you around.

If you like the look of a particular rehab, and you are ready to commit to treatment, then you can book a place. There are sometimes waiting lists for popular rehabs, so be aware that there may be a short delay before you can check in to rehab.

What happens when you check in to inpatient alcohol rehab?

When you arrive at the rehab, you will need to complete a quick medical and psychiatric examination. This will help the staff to know what your physical and mental health is like.

A trained member of the rehab staff will perform this examination, normally a psychiatrist. They will be able to prescribe medication to help you through detox.

They will also work with you to create a treatment plan. This will incorporate a detox, as well as various kinds of therapy and counselling. The treatments you decide to go for will depend on the specifics of your case.

What happens during detoxification?

Detoxification refers to the process of getting rid of toxins from your body. As mentioned previously, alcohol detox can cause unpleasant withdrawal symptoms. These typically set in around 6 to 8 hours after your first drink.

According to Noeline Latt, author of Addiction Medicine, alcohol withdrawal

is typically self-limited, involving overnight insomnia and morning ‘edginess’, which lasts until the first drink of the day. In more severe cases, symptoms may increase in severity over the next 48–72 h, and include anxiety, tremor, sweating, tachycardia, increased temperature, and pulse. In the most severe cases, withdrawal symptoms progress to delirium (delirium tremens), a life-threatening illness if not identified and treated early. ^[2]

As Latt points out, one of the most extreme withdrawal symptoms is delirium tremens, which can pose a serious threat to someone’s health and wellbeing if left untreated.

Another side effect of withdrawal is post-acute withdrawal syndrome (PAWS). A post-acute withdrawal syndrome typically affects long-term alcohol users, and sets in after the so-called ‘acute withdrawal phase’.

It can last for months, or even years in rare cases. Its symptoms include insomnia, depression, anxiety, low energy, inability to focus, brain fog and loss of libido. You can find out more about it here.

Given the risk of developing symptoms like delirium tremens, or long-term syndromes such as PAWS, alcohol detox should only ever be performed under medical supervision. In inpatient rehab, you can be sure that any withdrawal symptoms will be carefully monitored. The rehab staff will provide appropriate medication to help ease any symptoms.

Medication to ease withdrawal might involve benzodiazepines and anti-seizure medications. After detox is completed, medical staff can also prescribe anti-craving medications such as naltrexone and acamprosate. These anti-craving medications will help you to avoid a relapse in the early stages of abstinence.

What does alcohol rehabilitation involve?

Rehabilitation starts once the detox stage is over. It involves therapy and counselling. It attempts to address the root causes of addiction, and provides people with the tools to avoid relapse in the future.

Rehab incorporates a variety of treatment options. We go through some of the main ones below.

Individual therapy
Group therapy
Family therapy
Alternative therapy
12-step meetings

Individual therapy at inpatient rehab: how does it help recovery?

Individual therapy, also known as one-to-one therapy, is one of the cornerstones of good treatment. In individual therapy, the therapist speaks to the patient alone, without any other patients. This allows them to devote their complete attention to the patient.

Why do you need individual therapy? There is simply no other alternative when it comes to dealing with trauma and the roots of addiction. Group therapy has many benefits but is not as effective as one-to-one therapy for talking about traumatic episodes that might have led to addiction. Individual therapy also provides a much better environment for an individual to talk about their triggers with a therapist. Knowing your triggers is key to staying sober in the long run.

What are some examples of individual therapy approaches? Most forms of therapy can be done on a one-to-one basis. This includes cognitive behavioural therapy (CBT), dialectical behavioural therapy (DBT), acceptance and commitment therapy (ACT) and more.

Group therapy at inpatient rehab: what happens in a group therapy session?

Group therapy, as the name suggests, is a form of therapy that involves a group of patients and a therapist. Group therapy sessions often happen once a week in an outpatient setting, but in an inpatient setting, they are likely to happen every day. In a group therapy session for substance use, there will often be around 10-12 clients.

Why do you need group therapy? Group therapy sessions offer several things to patients in substance use recovery. First of all, they provide support, through the therapist and other patients. This is essential for people’s mental health. Addiction can be very isolating; being in a group of people in the same situation makes you feel connected and gives you a sense of solidarity with other people dealing with SUDs.

Group therapy sessions can also offer encouragement. This helps people remain abstinent even when they are going through intense cravings.

Finally, inpatient group therapy sessions can provide confrontation, when necessary. Denial is a common feature of many who go through SUD recovery; confrontation helps to overcome denial and therefore plays an important role in treatment.

What role does family therapy play in inpatient drug and alcohol rehab?

Family therapy sessions incorporate the family into addiction treatment. This serves a number of purposes. It can help to mend damaged relationships; it can work to create a better support bubble, and it can ease the transition from rehab back into the wider world.

It is worth remembering that the journey towards long-term sobriety does not end with rehab. You will have to try to remain abstinent in the real world, with commitments, stressors, triggers and cravings to deal with. Who is going to help you manage that transition? If you have family who you are close with, they may be able to offer some support.

What is ‘alternative’ therapy, and how it can help people in inpatient rehab?

Alternative therapy refers to treatments that treat the mind and body holistically, which means they do not focus on one particular symptom at the exclusion of others.

Examples of alternative therapies include acupuncture, meditation, light therapy, mindfulness, yoga, music therapy, equine therapy, art therapy and more.

What is the role of alternative therapy in an inpatient rehab programme? Alternative therapy is often offered alongside, or in conjunction with, more evidence-based therapies such as CBT. Though it cannot replace these therapies, it can complement them.

Can I attend 12-step meetings in inpatient rehab?

12-step meetings often play a part in inpatient rehab, with clients invited to attend these meetings in the evenings.

What is the 12-step programme? Twelve-step programmes, which began with the Alcoholics Anonymous (AA) programme in the 1930s and have since expanded to include multiple addictions, are a form of mutual aid organisation or support group which aim to help people recover from addiction. They tend to have a spiritual bent, although one does not have to be religious to attend.

Patients in inpatient rehab may begin attending 12-step meetings during their initial phase of recovery; they can then continue to attend these sessions once they leave rehab. This provides a sense of continuity which many find comforting.

Aftercare: what happens after inpatient rehab?

Aftercare refers to the treatment you get after inpatient rehab. The average stay in inpatient rehab for drug or alcohol use lasts around 4 weeks; aftercare, by contrast, can last for up to 2 years.

What does aftercare involve, and am I entitled to it? First of all, most good inpatient rehab programmes include a certain amount of aftercare as standard. This is to ensure that patients have the best chance of staying abstinent once they leave inpatient rehab.

As for what aftercare involves, that depends on your aftercare plan. This is something you create towards the end of your stay in inpatient rehab with the help of a counsellor or case manager. Your aftercare plan will include different forms of treatment which you find the most helpful.

Things that might be included as part of aftercare are:

12-step programmes
Alumni Programmes
Counselling
Medical care
Sober Living Homes
Support groups
Therapy

Given that between 40 and 60% of people relapse into substance use after getting sober, aftercare is of paramount importance. ^[3] It can make the difference between a relapse and continued abstinence.

What happens during a typical day in inpatient rehab?

Mornings in rehab begin with a healthy breakfast. During inpatient rehab, you will eat very nutritious food; this is to help you recover and to keep you healthy, especially through the withdrawal phase.

Some programmes offer alternative therapy sessions in the mornings, such as yoga and meditation. This is to help you get in the right headspace for the day.

You may have a group session after breakfast, in which you can work with other patients to learn tools for avoiding triggers and staying sober.

Afternoons are when the bulk of therapy happens. This includes individual and group therapy. You may engage in CBT with a therapist; you may also have group sessions in which you can offer and receive support. Family therapy sessions also occur around this time and any specialised sessions that you require. For example, if you have a specific co-dependency, you may require a specific kind of therapy, which can be given to you during the afternoons.

Free time may be allocated after you have finished an afternoon’s therapy; you can use this to read, go for a walk or pursue a hobby. There will be enough free time for you to do the things you love, but also not too much free time – during the rehab stage, you need to be occupied as much as possible.

Evenings are often the time for 12-step meetings. As outlined above, 12-step programmes provide a valuable form of comfort and routine, especially during the transition from rehab back into the world of work.

Lights out happens early in inpatient rehab: you need a good night’s sleep to help you recover.

What are the benefits of going to inpatient rehab for drugs or alcohol?

The main alternative to inpatient rehab is outpatient rehab. Outpatient rehab involves going to therapy sessions in an outpatient centre. It is often cheaper than inpatient rehab, and maybe better for those who are unable to take the time off work for a full stay in inpatient rehab.

However, if you are able to take the time off work, and your budget can stretch to it, inpatient rehab has several advantages over outpatient rehab.

First and foremost, inpatient rehab is the best environment in which to go through detoxification because it allows for 24/7 medical care. The withdrawal symptoms associated with alcohol detox can be severe and are best handled by medical professionals.

Another advantage of inpatient rehab is that it takes you away from your home environment. For someone who has got into a pattern of substance use, certain places can be full of triggers and stressors. Inpatient rehab removes these triggers and stressors, reducing the chances of a relapse. In inpatient rehab, you will have no access to substances, and you will be surrounded by people who are also in the process of going through detox and rehab. This provides a sense of solidarity and encourages you to stay on the path to abstinence.

Frequently asked questions (FAQs)

What can I bring for inpatient rehab?

Most inpatient rehabs provide a checklist of things to bring, but in case you didn’t get one, here is a shortlist of things to bring if you’re about to go to rehab.

Comfortable clothes
Some form of identification
Toiletries and hygiene products
Prescription medication in original packaging
Reading and writing materials
Pictures of loved ones

How long is the average stay in drug and alcohol inpatient rehab?

The average length of stay in rehab is 4 weeks. However, some stay for shorter lengths of time, and others longer. It really depends on your personal situation.

We would recommend a minimum stay of 2 weeks to get as much as possible out of your time in rehab.

Are there any rules of inpatient rehab I should know about?

Most of the rules in inpatient rehab are exactly what you would expect: no substances, no acts of violence, no leaving the property without permission.

Many rehabs insist on attendance at all therapy sessions unless permission is given to skip a session. They also insist on compliance with drug testing.

No phones is a common rule, as phones can provide an unnecessary temptation to communicate with dealers/enabling friends.

‘No relationships’ is there as a rule simply because patients are not in the right headspace to enter into a relationship during detox and rehab.

If you have any more queries, please check out our guide to starting rehab.

References

[1] Gov.UK, ‘Substance Misuse Treatment for Adults Statistics 2017 to 2018’. https://www.gov.uk/government/statistics/substance-misuse-treatment-for-adults-statistics-2017-to-2018/alcohol-and-drug-treatment-for-adults-statistics-summary-2017-to-2018

[2] Noeline Latt, Katherine Conigrave, John B. Saunders, E. Jane Marshall and David Nutt, Addiction Medicine, Oxford University Press, (Oxford, 2009), p. 79.

[3] NIDA. 2020, July 10. Treatment and Recovery. Retrieved from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery