Drug and Alcohol Rehab: What to Expect

Making the decision to enter drug and alcohol rehab isn’t easy—it takes courage and shows as strong motivation to change. However, you may be wondering what to expect at your upcoming treatment stay, including the daily routine, rules, and types of therapy and medication utilized. Knowing the treatment process, philosophy, and approach of your drug and alcohol rehab can help you prepare for and get the most out of your program. It’s also important to know what inpatient rehab and detox entails as well as outpatient.

Intake and Assessment

When you first arrive at your drug and alcohol rehab center, you will check in. This will likely consist of a review of the rehab’s rules since every program is different. Some typical rules may include:

• No laptops or cell phones
• No drugs or alcohol
• No leaving the rehab without permission
• People may visit at certain approved times
• No weapons
• No relationships during rehab

During this time, the staff may check that you didn’t bring any forbidden items. Asking your treatment program for a list of approved and unapproved items prior to attending will help you know what to pack for rehab.

Once you check in, you will complete an intake interview and biopsychosocial assessment, which will explore and evaluate your:¹

• Medical history
• Patterns of substance use
• Mental health
• Family history of substance use and mental health disorders
• Dependence and withdrawal risk
• History of trauma
• Availability of support systems
• Occupational, educational, and legal history

This assessment helps your treatment team to understand the biological, psychological, and social factors that have influenced your drug or alcohol misuse. They will use this information to create an individualized treatment plan for you that takes your unique needs into consideration. Tailored treatment plans are considered a best practice in substance abuse recovery settings and can help set you up for success.²

Detox: The First Step of Treatment

Depending on your intake assessment, you may need to go through detox in order to safely manage your withdrawal symptoms and help you achieve medical stabilization. Withdrawal symptoms vary from substance to substance, and some substances have more complicated withdrawal syndromes than others. Generally, withdrawal from alcohol, benzodiazepines, and barbiturates has the highest potential for dangerous and distressing symptoms, such as seizures and withdrawal delirium.³ Although not typically life-threatening, opioid withdrawal can be painful enough that it requires formal detox services to manage.

During detox, you’ll receive 24/7 care from a medical team of nurses, doctors, and detox counselors. Interventions may include:

• Drug and alcohol withdrawal medications
• Symptomatic medications
• Supportive care, such intravenous fluids or supplements for nutrient replacement
• Detox counseling

Detox can last anywhere from a few days to a couple of weeks. Factors, such as type of substance, co-occurring mental health disorders, medical issues, and length of addiction, can influence the length of withdrawal.

Drug and Alcohol Rehab Therapies

Once you complete drug or alcohol detox, you will begin various therapies to help build the foundation for recovery. There are many types of addiction therapy, and a typical daily routine may include family therapy, group therapy, individual counseling, and a skills group.

Evidence-Based Therapies

The term “evidence-based” means that these types of therapies are backed by extensive, replicable scientific research. Many different types of therapies may be used at treatment, each with its own approach.

Some types of evidence-based therapies that may be offered at your drug and alcohol rehab include:^4,5,6,7

• Dialectical behavioral therapy (DBT): You learn strategies and skills to help manage cravings and negative emotions, as well as how to avoid triggers for substance use. Originally created to treat borderline personality disorder, DBT is a great therapy for people struggling with co-occurring disorders, or a dual diagnosis.
• Cognitive-behavioral therapy (CBT): You and your therapist explore the connection between your thoughts, feelings, and behaviors in the context of your substance use. You will learn to identify and correct unhelpful behaviors and coping mechanisms.  
• Contingency management: You receive tangible rewards, such as voucher, prizes, or cash, for avoiding drug and alcohol use. These rewards are intended to reinforce abstinence.
• Family therapy: Substance use and addiction affect the entire family system. Family therapy seeks to validate you and your family members’ experiences, as well as improve communication and conflict-resolution.
• Interpersonal process groups: In a safe group space, you are able to recreate your past examine and rethink the issues that influenced your alcohol or drug use.

Holistic and Complementary Therapies

Complementary and holistic therapies may be used in conjunction with evidence-based interventions. The term “holistic” denotes a whole-person approach to addiction recovery, and these treatment modalities aim to heal your physical, mental, emotional, and spiritual health. They are not intended to use on their own to treat substance abuse, but rather, when they are combined with behavioral therapies, they can help to enhance your recovery.

Examples of common holistic therapies that may be offered include:

• Mindfulness and meditation
• Yoga
• Art therapy
• Music therapy
• Acupuncture
• Dance and movement therapy
• Equine therapy
• Tai Chi

Keep in mind that not every drug and alcohol rehab is going to offer complementary treatment methods. It all depends on the treatment facilities philosophy and approach.

Medications for Addiction

If applicable, your drug and alcohol rehab program may utilize pharmacotherapy as well as behavior and holistic therapies. The Food and Drug Administration (FDA) has approved medications for the treatment of opioid addiction and alcohol addiction.

Medications for opioid addiction include:⁸

• Methadone: A long-acting, full opioid agonist that alleviates opioid cravings and reduces the risk of relapse without producing a euphoric high
• Buprenorphine: A partial opioid agonist that also reduces cravings and has a low risk of relapse due to its ceiling effect
• Suboxone: A combination medication comprised of buprenorphine and naloxone, an opioid antagonist that reduces the likelihood of Suboxone abuse by inducing withdrawal in those who inject it
• Naltrexone: An opioid antagonist that blocks opioids from binding to opioid receptors in the brain, which prevents the desirable effects

Medications for alcohol use disorder include:⁹

• Naltrexone: An opioid antagonist that reduces alcohol cravings and blocks receptors responsible for the pleasurable effects of alcohol
• Acamprosate: Reduces symptoms of anxiety, depression, insomnia, and restlessness
• Disulfiram: Causes an unpleasant reaction when you use alcohol, which can reduce your desire to drink

A Sample Schedule for Inpatient Drug and Alcohol Rehab

Every rehab conducts itself differently and may adhere to a different daily routine, but here is a sample of what you can expect during a day at a treatment program:

• 7:00 a.m. Breakfast
• 7:45 a.m. Meditation
• 8:30 a.m. Individual therapy
• 10:00 a.m. Group counseling
• 11:00 a.m. Relapse prevention group
• 12:00 p.m. Lunch and reflection
• 1:00 p.m. Nutrition and wellness group
• 2:00 p.m. Alternative therapies, such as art therapy or equine therapy
• 3:00 p.m. Therapeutic community group
• 4:00 p.m. Physical wellness training
• 5:00 p.m. Dinner
• 6:30 p.m. Support group meeting
• 7:30 p.m. Structured sober activities and recreation
• 10:00 p.m. Lights out

As you can see, an inpatient drug and alcohol rehab program is very structured and intensive. Many people find they prefer adhering to a strict routine because it helps them to focus solely on their recovery, free of distractions and triggers.

Post-Rehab: Aftercare Planning and Ongoing Support

Although your drug and alcohol program will help build the foundation for a solid recovery, you are going to want to receive ongoing support. Recovery is a lifelong process full of its up and downs, and you’re going to want a solid support system and a plan in place. As you near the end of your treatment program, your treatment team will work with you to create your individualized aftercare plan.

Your plan may include various aftercare options, such as:

• Sober living homes
• Alcoholics Anonymous (AA)
• Narcotics Anonymous (NA)
• SMART Recovery
• Ongoing therapy
• Group counseling

Your drug and alcohol rehab program may also have its own alumni program that you can participate in, which connects you with other people who have completed the program. An alumni program can provide you with a much-needed sober support network.

If you are ready to find a drug and alcohol rehab program that’s right for you, call our confidential helpline at 800-908-4823 (Who Answers?) .

Resources

1. Substance Abuse and Mental Health Services Administration. (2020). Substance Use Disorder Treatment for People with Co-Occurring Disorders.
2. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Principles of Effective Treatment.
3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
4. Dimeff, L. A., & Linehan, M. M. (2008). Dialectical behavior therapy for substance abusers. Addiction science & clinical practice, 4(2), 39–47.
5. National Institute on Drug Abuse. (2018). Cognitive-Behavioral Therapy (Alcohol, Marijuana, Cocaine, Methamphetamine, Nicotine).
6. National Institute on Drug Abuse. (2018). Contingency Management Interventions/Motivational Incentives (Alcohol, Stimulants, Opioids, Marijuana, Nicotine.
7. Substance Abuse Treatment: Group Therapy [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2005. (Treatment Improvement Protocol (TIP) Series, No. 41.) 1 Groups and Substance Abuse Treatment. 
8. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: Opioid Addiction.
9. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: Alcohol Addiction.