What to Expect in Rehab: Inpatient Detox, Therapy, and Aftercare

One of the barriers to treatment for substance use disorder (SUD) can be the fears or concerns associated with treatment. However, though not all inpatient detoxification and rehab facilities are operated the same, you can still learn what to expect in rehab as you plan for treatment for an addiction to alcohol, illict drugs, or prescription drugs.

In this article:

• Checking in and Getting Assessed
• Detox in Inpatient Rehab
• Addiction Treatment
• Additional Considerations for Rehab and Detox
• Aftercare Planning

Checking in and Getting Assessed

When you arrive at an inpatient rehab facility, the first step of treatment will be intake and assessment. The treatment team will use many tools to assess you, including:^2,3,4,5

• Clinical interview
• Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
• Alcohol Use Disorders Identification Test (AUDIT)
• Drug Abuse Screen Test (DAST-10)
• Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS)
• Clinical Opiate Withdrawal Scale (COWS)
• Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)

These tools are used to diagnose, measure, and categorize your alcohol or drug addiction; they also provide clinicians with information regarding your risk for serious complications of withdrawal. Some of the information that is collected includes:^2,3,5,6

• Demographics
• Cultural and religious considerations
• Developmental and educational history
• Trauma history
• Medical and psychological history
• Substance use history
• Legal history
• Level of family and social support
• Amount and frequency of substance use
• Withdrawal symptoms (severity, risk of complications, history of withdrawal experiences)

Creating an Individualized Treatment Plan

Once you complete your evaluation, the treatment team will use this information to create an individualized treatment plan for you that will include the types of services and therapies you’ll be provided during inpatient rehab. For example, if you are at risk of experiencing withdrawal complications from a substance like alcohol or benzodiazepines, your treatment plan may include medical detox before beginning therapy and counseling. Medical detox involves 24/7 medical care and medications to alleviate withdrawal symptoms and cravings and increase your comfort throughout the process.

Not every inpatient rehab offers detox services, such as medical detox, so if you know or suspect your withdrawal symptoms will be severe, you’ll want to make sure to find a treatment program that offers detox as well.

Detox in Inpatient Rehab

Detox is the first step on the continuum of care for substance addiction. As you stop drinking alcohol or using drugs, your body will begin to eliminate the substances from your body. Many begin to experience withdrawal within 24-48 hours. Withdrawal symptoms vary between substances, with the most potentially dangerous withdrawal syndromes being associated with alcohol, benzodiazepines, and barbiturates. Opioid withdrawal also tends to be very distressing, though it isn’t typically life-threatening.

Withdrawal symptoms can range from mild to severe, with some of the most dangerous symptoms including seizures, agitation, hallucinations, and delirium tremens (potentially life-threatening alcohol withdrawal). Mental health symptoms like depression and anxiety can be concerning as well and may require around-the-clock care, especially if depression includes suicidal ideation.^6,7,8

Detox as part of inpatient rehab will include several modalities to keep you safe and comfortable during withdrawal, such as:

• Withdrawal medications to manage symptoms and cravings
• Supportive medical care, such as IV fluids
• Nutritional therapy, if necessary
• Symptomatic medications to manage individual symptoms not otherwise addressed by withdrawal medications
• Detox counseling

Detox services are not limited to certain substances—no matter who you are or what type of substance addiction you have, you could benefit from the monitoring, supervision, and oversight offered by professional detox services.

Detox Medications

While you detox in a facility, your symptoms will be continuously evaluated, and medications will be administered to manage your symptoms. The main Food and Drug Administration (FDA)-approved medications for substance withdrawal are the following:

• Benzodiazepines: A class of medications typically prescribed to treat panic and anxiety and alcohol withdrawal
• Buprenorphine: A partial opioid agonist that helps reduce symptoms of opioid withdrawal and cravings
• Methadone: A full opioid agonist that is prescribed to reduce cravings and manage opioid withdrawal symptoms

Additional medications may be prescribed to help treat symptoms of withdrawal and related anxiety or discomfort. These medications could include any of the following:^7,8,9

• Antidiarrheal and antinausea medications: Treats gastrointestinal symptoms associated with drug or alcohol withdrawal
• Baclofen: Helps reduce alcohol withdrawal anxiety and muscle cramps
• Beta-blockers: Treats anxiety and hyperarousal symptoms, such as high blood pressure and accelerated heart rate
• Carbamazepine: A tricyclic anticonvulsant that treats seizures
• Clonidine: Treats high blood pressure
• Gabapentin: Adjunctive treatment for seizures
• Pain medication (e.g., acetaminophen): Can help with body aches due to alcohol or drug withdrawal
• Topiramate: An anticonvulsant that can also help reduce hyperactivity and anxiety
• Valproate: Can help reduce seizures and protect from worsening withdrawal symptoms

Addiction Treatment

Once you finish detox and your withdrawal symptoms have resolved, you’re ready to begin your addiction treatment plan. Everyone’s treatment plan will be customized to meet their needs, but comprehensive treatment tends to include:¹

• Individual therapy
• Group counseling
• Family therapy
• Case management services
• Pharmacotherapy (e.g., relapse prevention medications)
• Peer support groups (e.g., Alcoholics Anonymous, Narcotics Anonymous, or SMART Recovery)
• Aftercare planning

Additionally, some treatment centers may offer holistic treatment modalities, such as mindfulness, yoga, creative arts therapy, and acupuncture, which can help aid in recovery.

Research indicates that effective detox, rehab, and continued treatment must:¹

• Be available and accessible
• Not be a one-size-fits-all approach
• Address problems that are associated with substance use
• Include various forms of therapy (i.e., individual, group, and family)
• Include opportunities for medication management
• Have a collaborative and individualized treatment plan
• Assess you, your symptoms, and needs continually
• Incorporate screening, assessment, and treatment of any comorbid disorders

Medications for Addiction

Medications may be used to help someone who has completed detox so they can maintain recovery from substance use. Your provider may also prescribe you medications to help prevent relapse. These medications could include:¹

• Acamprosate, which reduces cravings to drink alcohol
• Disulfiram (Antabuse), which, when used with alcohol, results in a very unpleasant reaction (e.g., heart palpitations, nausea, vomiting, and flushing)
• Naltrexone (Vivitrol, Revia), which could help reduce cravings and the rewarding effects of both alcohol and opioids
• Topiramate (Topamax, Trokendi XR, and Qudexy XR), which, although not entirely known, is believed to influence GABA and glutamate neurotransmitters to improve drinking outcomes
• Suboxone (buprenorphine/naloxone), which is used to reduce cravings and discourage opioid use for those recovering from opioid use disorder

Therapies for Addiction

Most inpatient rehab centers offer individual, family, and group therapy in the form of evidence-based behavioral therapies, which can include:¹

• Cognitive Behavioral Therapy (CBT), which helps those in recovery become aware of how their emotions and thoughts are tied to addictive behavior
• Contingency Management Interventions/Motivational Incentives, which provide rewards in exchange for positive behaviors, such as meeting goals or maintaining recovery
• Community Reinforcement Approach Plus Vouchers, which provides outpatient psychosocial treatment that helps change behaviors while also providing tangible gifts in exchange for maintaining abstinence from substances
• Motivational Enhancement Therapy, which aims to help individuals become motivated to change or continue treatment
• 12-Step Facilitation Therapy, which provides principles and actionable steps for individuals to follow to pursue recovery
• Family Behavior Therapy, which includes the individual and at least one other cohabitant or significant other to help address behaviors and co-occurring issues, such as conflict

Behavioral therapies help keep you motivated throughout your recovery.¹ While in therapy, your clinician will assist you in learning:¹

• Skills and strategies to cope with cravings
• Ways to prevent the reoccurrence of use
• Techniques to improve communication and relationships
• Parenting skills
• Emotional regulation and impulse control skills

Your mental health clinician may also assist with addressing other mental health disorders, such as depression, bipolar disorder, or panic disorder. Additionally, group therapies will help you develop social support and help you feel more connected to others. This is also beneficial as you transition out of treatment, as you have been able to build a recovery support network.

What to Expect in Rehab and Detox: Additional Considerations

During inpatient detoxification and rehab, you may have your own room if it’s an upscale center, but most standard rehabs will require you to share a room with another patient. Additionally, most inpatient rehabs will expect you to participate in communal living chores, and you will be provided with meals and likely have each day planned out for you. Visitors will also be limited to certain areas and times, and most visitors will need approval from your mental health care provider.

Aftercare Planning

Your treatment planning does not stop once you have entered detox and rehab; it is a continual process throughout your care. As you finish your detoxification and inpatient rehab, your treatment team will assist you in planning aftercare services and ideally will help you create a relapse prevention plan. This plan outlines:

• Your internal and external triggers
• Your internal and external coping skills
• Your natural support system (i.e., family)
• Your additional support system (i.e., group members, friends)
• Your professional support network (i.e., your physicians, therapists)
• Community resources (i.e., agencies and places that support recovery)
• Reasons for staying in recovery

Not everyone’s aftercare services will look the same. Aftercare recovery support can include:

• Intensive outpatient services
• Community-based therapists and support groups
• Sober living housing (SLH)

Intensive outpatient services are programs you attend for some time multiple days a week that provide specialized groups and therapy for SUD.

Community-based therapists and support groups are individuals and agencies that may be loosely related to your treatment facility but are still separate. Depending on where you live, this could provide a great opportunity to explore various types and modalities of therapy, along with exploring different forms of support groups.

Sober living houses are locations that allow individuals who have recently completed rehab to live together while supporting everyone’s recovery. SLH usually have at least one staff member who monitors if residents are committed to their recovery. Each SLH has its own separate set of rules and expectations; however, you are always expected to abstain from substance use.

If you believe you are experiencing substance use disorder and are interested in learning more about treatment options or what to expect in rehab, please call 800-908-4823 (Who Answers?) to speak with one of our treatment specialists.

Resources

1. National Institute on Drug Abuse. (2020). Principles of drug addiction treatment: A research-based guide (Third edition).
2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
3. Saunders, J. B., Aasland, O. G., Babor, T. F., de la Fuente, J. R., & Grant, M. (1993). Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption–II. Addiction, 88, 791-804.
4. National Institute on Drug Abuse. (2022). Screening and assessment tools chart.
5. Sullivan, J. T., Sykora, K., Schneiderman, J., Naranjo, C. A., & Sellers, E. M. (1989). Assessment of alcohol withdrawal: The revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar). British Journal of Addiction, 84(11), 1353-1357.
6. National Institute on Drug Abuse. (2015). Clinical opiate withdrawal scale.
7. Mirijello, A., D’Angelo, C., Ferrulli, A., Vassallo, G., Antonelli, M., Caputo, F., Leggio, L., Gabarrini, A., & Addolorato, G. (2015). Identification and management of alcohol withdrawal syndrome. Drugs, 75(4), 353-365.
8. Attilia, F., Perciballi, R., Rotondo, C., Capriglione, I., Iannuzzi, S., Attilia, M. L., Coriale, G., Vitali, M., Cereatti, F., Fiore, M., Ceccanti, M., Interdisciplinary Study Group CRARL – SITAC – SIPaD – SITD – SIPDip. (2018). Alcohol withdrawal syndrome: diagnostic and therapeutic methods. Rivista di Psichiatria. 53(3), 118-122.
9. Shah, M., Huecker, M. R. (2021). Opioid Withdrawal.