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A Guide to Sobriety: Getting Sober

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Substance abuse and mental health issues affect millions of Americans. An estimated 20 million people, ages 12 and older, had some form of a substance use disorder (SUD) in 2018. In addition, 47.6 million adults aged 18 and older in the United States suffer from mental illness. In many cases, people struggle with both SUD and mental health issues. Recent estimates indicate that more than 9 million adults had both a mental health and substance use disorder—referred to as having co-occurring disorders.1

While rehab can help with SUDs, it can also address underlying mental health issues.2 This guide discusses some of the questions you may have on your journey to sobriety.

Recognizing the Need for Addiction Help

Getting help for drug and/or alcohol abuse is an important start to the recovery process. For many people, this may begin when they admit they have a problem and reach out for help.

If a person is unsure whether they are misusing substances, there are ways to help determine if drug or alcohol use has become a problem. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) outlines distinct criteria for diagnosing problematic substance use behavior and substance use disorders. Though such diagnoses should be left to doctors or other treatment professionals, if you or a loved one have experienced two or more characteristic signs, symptoms, and behavioral changes in a 12-month period, you may meet criteria for a substance use disorder. Though the following is not a full list, some of these criteria include:8

  • Recurrent substance use that results in failure to fulfill work, school, and/or home obligations (e.g., absence from work or school, tardiness, neglecting household, or poor work and/or school performance)
  • Recurrent substance use that continues even in hazardous situations like driving or operating machinery
  • Recurrent substance use that results in legal troubles, such as arrests related to substance use
  • Continued substance use even after experiencing social or interpersonal problems that are caused by, or intensified by the use of the substance

For additional insight about any potentially problematic patterns of substance use, or if you or a loved one are struggling with substance misuse, call American Addiction Centers at (877) 721-2793.

Finding the Right Drug and Alcohol Rehab Program 

Every person is unique in their needs regarding substance use and mental health disorders, so not every treatment program is right for everyone across the board. There are thousands of treatment programs throughout the country, and you need to think about many factors when selecting the right one for you. In choosing a rehab program, various factors need to be considered, such as:

  • Cost.
  • Location.
  • Amenities.
  • Insurance coverage accepted.
  • Levels of care available/intensity of treatment.

If significant alcohol or sedative dependence (e.g., benzodiazepines such as Valium or Xanax) is a factor, you may need to first undergo a medical detox to manage withdrawal as safely as possible. In addition to keeping people as comfortable as possible during withdrawal, this will also help manage the risk of any potential withdrawal complications, such as seizures.3

Though opioid withdrawal may not present the same immediate risks as those associated with alcohol/sedative withdrawal, medical detox is commonly utilized at the start of treatment for opioid use disorders as well, to best help people manage the often markedly unpleasant withdrawal syndrome.3

Some programs may focus primarily on the detox period, meaning you may need to transfer elsewhere to complete a longer duration of comprehensive substance rehabilitation. However, many programs offer a continuum of care, with detox and ongoing treatment offered in the same facility.

You may also have other considerations in choosing a treatment program, such as being in a gender-specific program or one that is LGBTQ-friendly. Some rehab programs specialize in treating vets and first responders. Some people might prefer a program with a religious or spiritual focus.

Managing Withdrawal Symptoms

When a person engages in repeated and prolonged use of substances like alcohol or drugs, their brain gradually adjusts to the presence of these substances. As such adjustments accumulate, they become physiologically dependent on the substances in question and reliant upon them to feel “normal.” If a person with significant physiological dependence ceases to use a substance, or suddenly reduces their use, they may develop uncomfortable physical and mental symptoms, which together make up various withdrawal syndromes.9

While the effects of withdrawal can vary depending on the substance, examples of the kinds of symptoms you might experience include:10

  • Anxiety.
  • Restlessness.
  • Sleep problems.
  • Depression.
  • Changes in appetite.

If you or a loved one are concerned about the often unpleasant, and in some cases dangerous symptoms of withdrawal, medical detox and withdrawal management can help. Managing withdrawal under medical supervision will help ensure a safer, more comfortable cessation of drugs or alcohol.9, 10 Many drug and alcohol treatment centers offer medical detoxification as a first step in the recovery process. When detox is combined with other supportive services, such as individual and group therapy, support groups, and aftercare, lasting and positive recovery outcomes may be more likely than with just detox alone. 9

What Happens During Detox? 

When you go to detox, the goal is to manage your withdrawal in a safe, supervised way that minimizes your discomfort and decreases your risks of any medical complications. Though precise detoxification protocols and durations may vary, detox processes commonly consist of 3 important components: evaluation, stabilization, and the facilitation of additional substance abuse treatment.3

Medication is an important element of many detox protocols; detox medications may include different types of benzodiazepines or other anticonvulsant medications to prevent or manage seizures during alcohol withdrawal. People being treated for opioid use disorders may be stabilized and maintained on medications such as buprenorphine or methadone to manage unpleasant withdrawal and strong cravings for opioids during recovery.3

Regardless of whether detox takes place in a detox-only facility or in a program that also has ongoing treatment, it is important to understand that detox and withdrawal management is only the beginning of treatment. Merely clearing your body of drugs and alcohol does little to target the issues that led to compulsive use in the first place. Comprehensive rehabilitation efforts will incorporate ample counseling and behavioral therapy beyond the detox period to better prevent relapse and promote sustained recovery.3

Different Types of Addiction Treatment 

Addiction treatment is often portrayed on TV and in movies as a 24/7 program lasting a certain length of time. However, rehab is not always like you might have imagined it. While many people go to a 24/7 inpatient program, others do not sleep there—many rehabs offer outpatient programs. Relatively intensive levels of outpatient care include both intensive outpatient (IOP) and partial hospitalization (PHP) programs.

Inpatient Addiction Treatment

Inpatient treatment is necessary for some people, as determined by substance abuse professionals after your initial assessment. In many cases, people who are dependent on benzodiazepines or alcohol will need to have some inpatient treatment to provide 24/7 oversight and avoid complications that can be potentially life-threatening.3

People who have underlying medical issues or more severe forms of mental illness are often treated on an inpatient basis for safety. Inpatient rehab is often recommended for people with a history of prior failed treatment or an inability to get to an outpatient treatment program.3 While inpatient treatment can last anywhere from several days to weeks, it may also continue for several months, to fit different treatment needs.

Many inpatient treatment programs encourage 12-step group participation, and incorporate Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) meetings to facilitate recovery. Other programs may host similar mutual support group sessions, though not necessarily those built on the 12-step model. There may also be specialty programs such as equine therapy or holistic therapy. Regardless of the amenities or specific treatment approach, many programs use some form of behavioral therapy to help people make positive adjustments to their thoughts and behaviors surrounding drug use, increase their coping skills, decrease relapses, and ultimately promote a new life in recovery.4

Outpatient Addiction Treatment           

Though outpatient programs sometimes function as “step-down” treatment after a person leaves a more intensive inpatient or residential program, some people utilize outpatient treatment settings as their first entry point for substance abuse rehabilitation.4 Many outpatient programs offer the same type of programming as inpatient treatment. However, the person goes home at night and can sometimes keep working and attending school. Outpatient treatment can last for weeks in many cases.

Partial Hospitalization Program 

Partial hospitalization programs, also called PHPs, are outpatient treatment programs that typically operate 5-7 days per week for 4-6 hours per day. The programming and range of clinical services available are often very similar to inpatient treatment, but the person goes home at night. Like outpatient programs, they may be used as a step-down from inpatient treatment. Some people do go to a PHP as their initial point of rehabilitation services, but this depends on numerous factors regarding their substance use and treatment needs.5

Intensive Outpatient Program 

An intensive outpatient program (IOP) is relatively less time-intensive than a PHP. A person may expect to participate with groups and other programming 2-3 hours a day, 2-3 days a week. IOPs can also be a step-down from a PHP or inpatient treatment, but like a PHP, it can also be the first step in treatment.6 ASAM standards suggest at least 9 hours per week for an IOP.

Aftercare and Recovery Support Networks

Whether a person goes to inpatient treatment, an IOP, or a PHP, aftercare is crucial in helping you maintain your recovery. Aftercare can help reinforce the skills learned in rehab to help prevent you from relapsing into drug use. Examples of aftercare include AA, NA, SMART Recovery, and other support groups. Aftercare should focus on following a recovery plan to help prevent relapse.7

Regardless of what type of treatment you go to, it is important to get treatment for an SUD. Detox may be your first step on your recovery journey, but remember it is only the beginning of treatment. Depending on your personal situation and the many factors that influence the outcome, you may be in outpatient or inpatient treatment. Aftercare on a longer-term basis is the ideal way to follow up on any type of substance use treatment to ensure that you do not relapse.

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Dr. Thomas received his medical degree from the University of California, San Diego School of Medicine. During his medical studies, Dr. Thomas saw firsthand the multitude of lives impacted by struggles with substance abuse and addiction, motivating him to seek a clinical psychiatry preceptorship at the San Diego VA Hospital’s Inpatient Alcohol and Drug Treatment Program. In his post-graduate clinical work, Dr. Thomas later applied the tenets he learned to help guide his therapeutic approach with many patients in need of substance treatment. In his current capacity as Senior Medical Editor for American Addiction Centers, Dr. Thomas, works to provide accurate, authoritative information to those seeking help for substance abuse and behavioral health issues.
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