Inpatient Alcohol Rehab: What to Expect

Alcohol misuse and alcohol use disorders are not isolated incidents. They have physiological impacts resulting in liver disease, heart disease, and cancer; they may even prove life-threatening.¹ Thus, there are many reasons to stop misusing alcohol. However, stopping alcohol misuse may not be as simple as quitting cold turkey. For anything more than mild addiction, you may need inpatient alcohol rehab and detoxification. But what happens in inpatient alcohol treatment?

In this article:

• What is the Process for Inpatient Alcohol Treatment?
• Who is a Candidate for Inpatient Alcohol Rehab?
• How to Find Inpatient Alcohol Treatment

What is the Process for Inpatient Alcohol Treatment?

Inpatient alcohol rehab usually involves an initial intake and assessment, detoxification, full treatment to be received at the facility, and aftercare. It is generally accepted that if you need the level of care that is offered at an inpatient level, then you will go through these steps.

Intake and Assessment

Intake and assessment focus on getting you the most appropriate level of care based on the information you are willing to disclose. This information regards your symptoms, substance use, social functioning, level of impairment, and more.² Your assessor determines the level of care you need to move forward based on inclusionary criteria that include:²

• Method of use (e.g., intravenous versus oral consumption)
• Whether you are currently intoxicated
• Dosage
• Frequency
• Any existing periods of sobriety and their duration
• Immediate medical needs such as active withdrawal
• History of withdrawals that get progressively worse
• History of any mental health concerns
• Duration of overall substance use

Assessment happens throughout your treatment. This way, providers can adjust your level of care to help you move forward on the path to recovery.

Detoxification

Detoxification, or detox, is not a stand-alone treatment and is merely the first step of the continuum of care. Detox aims at managing acute intoxication and withdrawal symptoms to prevent life-threatening complications that could arise if left unaddressed.²

There are three steps to alcohol detox:²

1. Evaluation: Your supervisor assesses if alcohol is present in your bloodstream, measures its concentration, and screens for physical or mental health concerns.
2. Stabilization: Medical and psychosocial interventions help you manage uncomfortable withdrawal symptoms until you are medically stable and substance free. Medication-assisted treatment (MAT) often is utilized here.
3. Preparation to enter treatment: You will be informed about what to expect during treatment and familiarized with the facility environment.

Once detox is completed, you will be connected to a treatment center. This may be the same facility as the detox program or it may be located elsewhere.

Inpatient Treatment and Medical Care

As opposed to outpatient care, inpatient alcohol rehab is reserved for patients who may have complicated withdrawals. These are characterized by medical conditions such as seizures, delirium tremens, or psychiatric conditions.² When trying to determine if inpatient alcohol rehab is the best fit for you, you may want to consider the following:²

• Do you have a history of seizures or delirium tremens associated with your withdrawals?
• Are you dually diagnosed with a psychiatric condition that has symptoms of suicidality or homicidality?
• Are you able and willing to follow treatment recommendations?
• Do you have any medical conditions that are not being addressed?
• Do you have a supportive person to help you during this process?

Alcohol negatively impacts many body organs and systems, such as the liver, pancreas, and endocrine system. It also causes several nutrient deficiencies—magnesium, fat, protein, iron, zinc, vitamins A and E, and water-soluble vitamins such as thiamine, pyridoxine, vitamin B12, and folate. Thus, a nutritional focus may be part of your regimen as well.²

Medication-Assisted Treatment for Alcohol Addiction

Inpatient rehab is similar to inpatient treatment for other substances. Both involve medication-assisted treatment (MAT) used in conjunction with behavioral therapies.³ If you decide that inpatient alcohol rehab is a good fit for you, you can expect to be prescribed one of the following:³

• Acamprosate: This medication typically is prescribed on the fifth day of no alcohol use and is taken orally at the same time every day three times a day. It is fully effective in five to eight days. It helps you abstain from alcohol but does not prevent withdrawal symptoms.
• Disulfiram: This medication is taken orally once a day and is meant for those who already have been through detoxification or are in the initial stage of abstinence. If you drink alcohol while taking this medication, you will experience nausea, vomiting, headaches, difficulty breathing, and chest pain in as little as ten minutes. This can last for an hour or longer.
• Naltrexone: This medication blocks euphoria associated with alcohol use. It helps you maintain motivation to remain medication compliant, stay in treatment, and avoid relapses.

None of these medications are a cure for alcohol use disorder itself. Rather, they are used to complement behavioral therapies, together addressing the needs of the whole person.

Therapies Used in Inpatient Alcohol Rehab

Inpatient alcohol rehab may involve individual, group, or family therapy. Behavioral therapies are a common choice of rehab facilities. These types of therapies are designed to help you:⁴

• Learn strategies and coping skills to deal with cravings and avoid relapse
• Improve your communication
• Better your relationships
• Bolster your parenting skills
• Manage and self-regulate your emotions

Several behavioral therapies effectively treat alcohol use disorder. These include:⁴

• 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.

Aftercare Planning

Planning your aftercare program is just as important as the beginning stages of sobriety. Aftercare helps you translate what you have learned in treatment to a sober life outside the inpatient facility. It helps you continue to reinforce and practice what was learned by continuing counseling, refining and fortifying strategies to avoid relapse, and engaging in ongoing prevention, aftercare, and home behaviors.¹ This can look like:²

• Continued participation in Alcoholics Anonymous (AA) groups
• Finding or maintaining meetings with a sponsor
• Enrolling in groups that are more specific to other identified problems while you were in treatment (e.g., co-dependence, parenting classes, domestic violence classes)
• Addressing any legal issues (e.g., requirements of probation, restitution, meetings with Child and Family Services)
• Establishing and maintaining a structured routine
• Identifying, establishing, maintaining, and frequently reinforcing appropriate boundaries
• Slowly integrating certain support systems back into your life

Who is a Candidate for Inpatient Alcohol Rehab?

Inpatient alcohol rehab is intended for you if you have:²

• Delirium tremens (shaking, irregular heart rate, and possible hallucinations)
• Seizures during withdrawal
• Severe withdrawals
• Multiple withdrawals
• No capacity to give informed consent
• Co-occurring medical conditions
• Psychiatric issues or self-harm tendencies
• Inability to follow recommendations for treatment
• Inability to arrive at a clinic daily
• Lack of support group or persons

Keep in mind that alcohol misuse can exacerbate psychiatric symptoms and reduce treatment compliance to psychotropic medications and psychosocial treatment.⁵ In such cases, inpatient alcohol rehab would be advisable.

How to Find Inpatient Alcohol Treatment

Pursuing help with your alcohol use can be intimidating and confusing. However, help exists that can clarify your questions or concerns and put you on the road to recovery. Call 800-908-4823 (Who Answers?) to talk to a treatment specialist to discuss available treatment options for alcohol use disorder. They will help you find the right inpatient alcohol rehab program for you.

Resources

1. Carvalho, A. F., Heilig, M., Perez, A., Probst, C., & Rehm, J. (2019). Alcohol Use Disorders. The Lancet, 394(10200), 781-792.
2. Substance Abuse and Mental Health Services Administration (SAMHSA). (2015). Detoxification and Substance Abuse Treatment.
3. Substance Abuse and Mental Health Services Administration (SAMHSA). (2022). MAT Medications, Counseling, and Related Conditions.
4. National Institute on Drug Abuse. (2020). Principles of drug addiction treatment: A research-based guide (Third edition).
5. Robertson, A. G, Easter, M. M., Lin, H., Frisman, L. K., Swanson, J. W., & Swartz, M. S. (2018). Medication-Assisted Treatment for Alcohol-Dependent Adults with Serious Mental Illness and Criminal Justice Involvement: Effects on Treatment Utilization and Outcomes. American Journal of Psychiatry, 175(7), 665-673.