Any money left?
Money is one factor. If an alcoholic still has cash available or a health insurance policy that will cover treatment in a rehab clinic, this will often be the first option. The treatment will be more feather-bedded than a cold turkey in an unheated bedsit. But beware, if the clinic is more like a five-star hotel than a hospital it may be too comfortable for the patient to face up to harsh realities. More than one successful non-drinker has told me that first they went to a treatment center which treated them very nicely and it didn’t work. The ones that did work on a later occasion had a much tougher regime. I would avoid clinics that look like a five-star hotel in the brochure or on the internet with a swimming pool set out for sun bathing. These are more appropriate for temporary detoxes.
Usually clinics start treatment with four days on diazepam, formerly better known under the trade name Valium – until it was discovered to be addictive with long term use. Then the group therapy, one-to-one counseling, and lectures on addiction will begin. Sometimes a 12 step program will be embarked on in the clinic, to be followed up with a recommendation to attend AA after the treatment ends. Very often AA will be recommended as a maintenance program after treatment.
But not always. Sometimes the line is: “you’re OK now, off you go and if you have any problems come back and see us.” Sometimes clinics run their own weekly meetings of patients after they have left treatment. I know many alcoholics who don’t go to meetings, but keep in touch with other alcoholics through regular lunch dates or social encounters. However, knowing how many alcoholics that don’t attend meetings relapse, I would recommend continued attendance. Further, my observation of alcoholics who attend meetings but don’t do the steps is that they are in a limbo land somewhere between white-knuckling it (with no meetings) and being a happy, contented individual (who does the steps thoroughly). For them, I would recommend my latest book Secular AA.
Options are fewer if resources are limited. It may be possible to negotiate an outpatient program with a treatment centre or there may be publicly funded beds available in a drug and alcohol unit but there will usually be a waiting list for these, which lengthens if you’re a second-time or third-time applicant. I have met someone who went into clinics 27 times but his funding was private. For some lucky alcoholics there may be a charity-funded place available on a two-year program with one year in a clinic and one in a half-way house before being turned out to face the world alone. Most of these organisations are keen for patients to attend AA meetings as well.
A drawback of these treatments is the wait for a place. Some suggest that alcoholics continue drinking until a place becomes available. This doesn’t seem right to me. If there is some willingness to attempt to draw a halt to drinking, it seems a pity not to tap into it while it exists.
But I suppose these places aim to cater for no-hopers who have tried everything else. It is often said that people need to seek help for themselves, it is no good trying to do it for a wife or family or employer. That is because you cannot lock them up against their will and make sure no drink can pass their lips. But this option of willing admittance to a closed unit is the nearest alcoholics can get to being locked up against their will.
Some alcoholics gain admittance to hospital or clinics on an emergency basis when they have almost drunk themselves to death. But it is not a course to be recommended on purpose because the tolerances are very hard to estimate and it is easy to end it all by mistake. One of the more spectacular ends associated with cirrhosis of the liver is an esophageal haemorrhage whereby the body drains of blood via a fountain that hits the medical room ceiling.
One of the sales pitches by clinics is for an individually tailored, custom-built treatment, implying other options are one-size-fits-all. But 12 step programs are designed to be custom-built, too. Don’t assume they are rigidly applied to all alike.