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Key Components to Selecting a Residential Alcohol Rehab

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Page Overview

When you start looking around at different alcohol rehabs, you will find a wide array of residential rehab options offering and boasting an amazing variety of treatments and claims. So you’re probably wondering where to even start the selection process. In order to find the right program, look for the one which gives you or your loved one the best chance of success while also accepting your insurance and/or being affordable for your budget. Taking time to investigate certain aspects will go a long way in easing your mind and uncovering the best option.

Basically, the most successful residential rehabs address all 3 spheres – Spirit, Mind, and Body – equipping the alcoholic with psychological skills based on spiritual truths, and producing healthy decision-making and lasting transformation. Let’s discuss the key components for this holistic Bio-Psycho-Spiritual Approach; research-based methods, options for medical detox and rehab, availability of psychiatric services, structured psychotherapy, Christian-based component, credentialing of the treatment staff, and a customized treatment and after care program.

Learn more about selecting the right alcohol rehab here.

There are numerous programs and therapies popping up all over the country promising quick results, easier recovery, or new and unique methods. If a treatment center can’t show evidence that their program is truly effective, don’t even consider enrolling. Before committing to a program, be sure the methods and therapies used have been proven through research or clinical trials. The best therapies are still the ones that have been studied and proven over time and widely accepted by experts to be effective. If your treatment center is going to use a therapy, it had better be research-based. Otherwise you can waste a lot of time, money, and heartache trying new fads that don’t really work.

    The main research-proven components for successful rehab are:
  • Medical detox when physical alcohol dependence exists
  • Psychotherapy to address the underlying issues which lead to alcohol abuse
  • Better credentialed treatment staff deliver more effective therapy
  • Psychiatric evaluation and treatment for a co-existing psychiatric issue like Depression, PTSD, Bipolar, Panic Disorder, Social Anxiety, Schizophrenia, ADHD, etc.
  • A structured intensive program that builds self-discipline, order, and confidence in life management skills
  • Faith-based (especially, and most studied, is Christian) programming to integrate and address spiritual issues including purpose, value, forgiveness, joy, values, morals, adversity, etc.
  • Longer treatment stays to learn and practice skills under supervision are better than short treatment stays
  • A very specific aftercare treatment and growth strategy in place and followed after discharge from rehab
  • Faith of therapist matching faith of the patient

Healing the Body

You and your loved one, with the help of a doctor or treatment professional, need to evaluate your loved one’s needs, and determine if medical rehab would be the most beneficial. If medical rehab is recommended, make sure you find a rehab that offers this thorough medical detox and examination component.
Dr. Karl Benzio

Medical Detox

Most residential alcohol rehabs offer some form of ‘social detox,’ but because almost every alcoholic is physically dependent on alcohol, medical detox is a must. This highest level of detox – medically supervised, aka medically managed detox – has the medical expertise that social detox doesn’t and is important to avoid death, seizures, or serious physical injury. Also, during this most challenging stage of recovery, medically supervised detox makes your loved one more comfortable and thus less likely to abruptly leave rehab AMA (Against Medical Advice) to get a drink as their own way to stop the torture of withdrawal symptoms.

During medical detox, medications similar to but safer than alcohol called benzodiazepines, such as clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan), are used. These medications wean off alcohol, decrease anxiety, and neutralize life threatening withdrawal reactions, especially seizures. Depending on the severity, antipsychotic medication for hallucinations or delirium might also be necessary. Many irritating withdrawal symptoms also occur like insomnia, tremor, digestive issues, etc, and milder medications to ease or block these are administered.

Medical detox can only be performed by a facility that is licensed to provide medical care, so ask your preferred center specifically to see what they offer. Some treatment centers don’t provide this medically supervised/managed detox but have collaborations with detox facilities or area hospitals that can.

Medical Rehab

Once safely detoxed, many other physical/body sphere issues need medical evaluation and attention because alcoholism is often associated with:

  • Toxic chemical effects producing ulcers, liver and esophagus issues, diabetes, strokes, heart disease, neurological impairments, cancers, etc.
  • Poor nutrition, bad eating habits, minimal exercise, and sedentary lifestyle which damages many body systems leading to anemia, bleeding issues, weight problems, high cholesterol and blood pressure, joint and back problems, etc.
  • Falls, car accidents, and other traumas while drunk or from fights leading to concussions, back and joint pain, and internal organ damage

Only facilities with a physician (usually a family practice or primary care doctor) to perform a thorough physical exam and order blood work or other medical tests are able to uncover and address these problems. The facility then starts a good diet with vitamins and supplements to heal the body and brain, reconditions the body through exercise, and the program and schedule are essential for promoting good sleep rhythm and routine. Some rehabs will have a gym, yoga, or outdoor activities while others do neurotransmitter testing to see what supplements will help brain circuitry heal and work more efficiently.

While the foundation for alcohol recovery and transformation is psychological healing and spiritual awakening, many people find that medication provides an added benefit to get over some major hurdles during the initial stages of abstinence and recovery. Medications like disulfiram (Antabuse), Naltrexone (Revia), Vivitrol, Campral, and Topamax are sometimes beneficial in the first 12 months to reduce cravings and expedite the recovery process.

Psychiatry for Co-Existing Disorders (Brain and Mind)

Alcoholism is always a poor coping skill one develops to combat an inner psychological problem. Sometimes that problem has no diagnosis, like poor self-esteem, hurt from a rejecting or absent father, or insecurity in social settings. But sometimes a diagnosable psychiatric (mental health) issue exists. This is called Co-existing Disorder or Dual Diagnosis. Sometimes this co-existing disorder came first and the alcohol was to escape or self-medicate the disorder. For others, the heavy use of alcohol damaging the brain and/or dealing with the many consequences of alcoholism causes a psychiatric disorder.

These psychiatric disorders can be depression, anxiety disorders, PTSD, Bipolar disorder, ADHD, and Schizophrenia to name a few. Regardless of which came first, the alcoholism or the psychiatric disorder, research clearly shows if the person has a psychiatric illness on top of alcoholism, treating them both at the same time leads to the best chance of recovery success. Simply stated, treating the addiction without simultaneously treating the psychiatric disorder almost always leads to quick relapse.

It is imperative, therefore, that if your loved one is going to overcome alcoholism, they be evaluated by a psychiatrist for a co-occurring disorder. When seeking help for alcoholism, you should find a treatment center with a psychiatrist who screens for and treats (with medications if appropriate and helpful) mental health disorders, and therapists with psychotherapy expertise to treat both the addiction and mental health issue together. When you screen treatment centers, ask if they offer psychiatric evaluation and intensive therapist treatment for co-existing psychiatric disorders. If not, you will need to look elsewhere.

PsychoTherapy (Brain, Mind, and Spirit)

The main treatment engine for most recovery programs is psychological therapy to get at the underlying issues that interfere with the alcoholic being able to process life and make healthy decisions. Psychotherapy, often called talk therapy, takes time, usually involves several different approaches and is delivered in varying formats. Common talk therapies include Behavioral, Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Trauma Therapy, and Family Therapy.

Psychotherapy facilitates real change, as the person comes to understand who they are, their addiction, what caused it, what allowed it to continue, and how to change their thoughts and attitudes to allow for long-term sobriety. There are many different types of psychotherapy – some are effective and some are a bunch of fluff. Below are some therapies that are research proven to produce positive life-change results.

Behavioral Therapy (or Behavior Modification). This is the most common form of talk therapy in rehabs. It is the simplest but the least effective if no other therapy is added to it. The focus is modifying a person’s behaviors to treat their alcoholism.

    Examples would be:
  • Change your behavior of driving a certain route home so you don’t drive by the bar you are tempted to go into for happy hour. Modifying behaviors is important, but if you don’t work on the deeper issue, you will just find a new bar on your new route.
  • While in rehab, teaching good habits of waking up, making your bed, eating breakfast are important starts, but if you don’t address the underlying thinking, attitude, hurt or wound, the alcoholic will soon revert back to unhealthy life habits and relapse.

Behavior therapy is easy to teach so facilities with minimally qualified counselors, like someone with a certificate in addictions counseling, will use Behavioral Therapy as the main form of therapy, never getting at the underlying issue or producing an inner change, thus leading to a quick relapse.

Cognitive Behavioral Therapy (CBT). CBT realizes our external behaviors are the output of our internal database in our brain and processing system of our mind. This deeper therapy is the foundation for most lasting success and looks to uncover and correct the faulty thought patterns which lead to our dysfunctional behaviors. Remember, addiction is a person’s unhealthy coping system for their inner struggles, whether real or perceived struggles. If the addict is given the training and tools to change their negative thought (cognitive) patterns, they can learn to deal with stress and conflict in a healthier way that doesn’t involve drug or alcohol behaviors. Masters level or licensed therapists are more often trained in this therapy so you want to make sure of the therapists’ credentials and style.

Trauma Therapy. Alcoholism and drug addiction commonly have their beginnings in a major trauma, or many minor traumatic experiences. Often addiction is somehow fueled by various ongoing traumatic or significantly hurtful events. During trauma therapy, the patient learns how to uncover, then re-process in a more accurate way, and ultimately deal with, unresolved trauma in a therapeutic setting; in essence bringing healing into those dark past wounds. This therapy recognizes the individual in recovery as resilient and as possessing the ability to continue on and take control of their life despite challenges. Trauma therapy can be messy and should only be done by a licensed Masters or PhD level therapist with both experience and expertise. If not, the damage could be worse than the original trauma.

Dialectical Behavioral Therapy (DBT). An offshoot of CBT, DBT is a cognitive behavioral treatment that teaches how to be grounded and aware of the moment, managing stress, dealing effectively with others, and regulating your own emotions. Individuals learn basic skills to identify and cognitively process their emotions so emotions won’t overwhelm or frighten them. Emotions are important to enjoying life and making decisions, but many don’t know how to handle their uncomfortable feelings very well so they use alcohol to numb, escape, or self-medicate these feelings. DBT slows our mind down so we can manage emotions and incorporate them into a healthy decision making system for lasting success. DBT is intricate and should only be done by a licensed Masters or PhD level therapist with experience and expertise.

Various other talk therapies like Emotion Focused Therapy, Motivational Interviewing, Gestalt Therapy, Systems Therapy, and psychodynamic psychotherapy are helpful and incorporate much of the elements we discussed above. Some less conventional therapies, called experiential therapies, like art, music, equine, or pet therapy incorporate experiences as the medium to teach a person more about themselves, skills, and life.

All of these therapies can be used in various formats including individual therapy a couple times per week, several group therapy sessions per day, psychodrama, and family therapy. Ask the treatment staff what types of psychotherapy or talk therapy they use, and how they use these therapies to help your loved one transform their mind and attitudes to produce healthy decisions and behaviors.

Staff Credentialing

In discussing the many major therapies above, you can see the power and effectiveness possible by several sessions a day over several months of a rehab stay. But if the staff member leading the therapy doesn’t have the expertise, training, or experience to apply these to you or your loved one, no progress will be achieved. In fact, the alcoholic will feel like their rehab wasn’t helpful, or after a week, they know as much as the staff and are ready to come home.

Many rehabs have well-meaning, but poorly trained and inexperienced recovering addicts who have no formal training or a minimal certificate program but no psychotherapy training or skills as the counselor and main treatment provider of the alcoholic. Unfortunately, this is the main reason for the poor success rates and revolving door situation most rehabs experience as the alcoholic receives sub-standard treatment, and almost comes out worse than when they went in by getting misinformation from the under-qualified treatment team.

Christian Component

If you are looking for an excellent rehab, consider one with a Christian component. These programs use truths that have withstood the test of time, and apply to each and every person’s life, no matter what their background is. The basis for Christian rehab is that we all make mistakes, are sinful, and turn our backs on God and those we love. We try to live life based on our own instruction manual instead of His, the B.I.B.L.E. (Best Instruction Book for Living Everyday). But through repentance, forgiveness, and a closer walk with God, we can experience changes in behavior, thoughts, and attitudes, which can turn our lives around. A Christian rehab will use these methods in the light of God’s word, the BIBLE, and His will for us. Christian therapy stresses the importance of trusting God’s ways and His power to help us through whatever challenges we face.

Christian Therapy. A true Christian therapy program will help individuals transform their lives through a closer relationship with God, accessing His divine power. But faith-based therapy is not just for the religious – it has beneficial qualities for everyone. Building powerfully on CBT and the various therapies we discussed above, in order to retrain and correct your thinking, a patient must determine what values, morals, and set of absolutes they will adopt and base their new thinking on. Here are a couple of examples of why and how these absolutes are so vital:

  • Know the truth, that is seeing life clearly and accurately
  • Use a value or moral system to guide our behaviors
  • Engage with a higher power for parts of life outside of our control
  • Forgive others or our self for healing from traumas or our own wrongs
  • Have a big picture view to understand and handle adversity and conflict
  • Where to get hope so you can really change
  • Feel loved and belonging so you can give love and relationship to others

Through Bible study, prayer, reflection on God’s will, and learning His life-management instructions, individuals renew their thinking based on our Creator’s guidelines, and then experience peace in God’s forgiveness of their past wrongs, love in their Savior Jesus Christ, and new life in the Holy Spirit. As you can imagine, without Christian therapy’s attributes, CBT, DBT, and trauma therapy are limited, but with Christian therapy, those other therapies are deeper and more powerful and research shows, more successful to equip the alcoholic for lasting recovery and transformation.

Customized Treatment

If you or your loved one is going to invest money, time, energy, and heartache into an alcohol rehab, you need it to be effective. You deserve to have a specific treatment plan created. Don’t settle for a plan that was designed with someone else in mind. Customized treatment means a thorough evaluation leading to the details of a recovery plan that are based on the unique characteristics from the evaluation and ongoing treatment process – the detox process, the length of time the person is in rehab, medical and psychiatric attention, the different therapy sessions they take part in, the focus on the therapies, and the type of support they require for after care. Individualized rehab, not cookie cutter one-size-fits-all, is by far the most effective because it really addresses all 3 spheres while getting to the root problems, and then builds a strong foundation to build a new life on.

After Care

Like a rehab plan, an after care plan must be tailored to meet your loved one’s needs. Does your loved one need to live in sober housing for a time until they get back on their feet and resume all the pre-treatment responsibilities and pressures? How are they going to stay on the right path, everyday? How often can they continue to meet with counselors, and how much does this cost? What options are there for alumni participation, tune-ups, ongoing family therapy, and life skills training? What kind of support does the facility provide its clients after rehab? Ask questions about after care options, so that you and your family can plan ahead. After care programs are proven to decrease the incidence of relapse.

Finding the right residential alcohol rehab will take some investigating, but you can consult your doctor or a professional referral service, ideally ones with clinicians who know the treatment needs an alcoholic requires to turn their life around. Spending the extra time and effort now to find the best rehab with a compassionate and deeply detailed Spirit, Mind, Body approach will save you so much energy, time, and expense in the future.