What Is Best for Alcoholism—Rehab, Alcoholics Anonymous, or Both?

Dear GoodTherapy.org,

With the help of my friends and family, and particularly a recent intervention they had for me, I’m coming to terms with the fact I’m an alcoholic. I started drinking socially as a teenager. I drank excessively on a frequent basis and continued into adulthood. I am 31 years old, and until recently I didn’t think anything of my drinking habits. After getting a DUI and the intervention I mentioned, I’m realizing my alcoholism has impacted my life (and the lives of people I love) for a while now.

I was a social drinker to start, even into my early 20s. Nowadays, I prefer to drink at home, usually by myself. It’s cheaper than going out to a bar, and coordinating plans with friends can be stressful and annoying. I can admit that I’ve been isolating to hide my drinking from others, to avoid needing to make excuses for drinking or having to explain whether I remember something or if I blacked out. The night I got my DUI, by the way, I don’t remember at all.

My recent experiences have shown me that I need help, but I don’t know where to start. Some people have recommended 12-step programs like Alcoholics Anonymous, and others think I need intensive rehab treatment. So I’m wondering which one I should try first. Should I try both? I have never tried to stop drinking and am worried that if I try to quit cold turkey, I will suffer severe alcohol withdrawal symptoms and relapse. Please help me with some ideas on how to get started so I can plan the best recovery strategy. —Craving Sobriety

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Dear Craving,

First of all, congratulations on taking a crucial first step: you have gotten honest with yourself and declared yourself powerless (in the language of recovery) over alcohol. As with all recovery concepts, should you go that route, you’ll get to decide what this means to you. One sober client said it to me this way: “To me, it means when I can control my drinking, I don’t enjoy it, and when I enjoy it, I can’t control it.”

I have personally been in several recovery programs. I also worked as a counselor in a rehab facility and I now have my own private practice, so you’ve come to the right guy. It’s also true you’ll get “Darren’s take” here and—this is crucial—there is no “perfect” way to do this. A lot of sobriety is exploration, trial, and error. The only “mistake” is to give up and go back to the bottle.

I firmly believe those of us on a sober path are not “bad” people trying to be “good”; we’re afflicted or wounded people trying to get well.

If you’re sober, you’re winning.

This is the best gift you could ever give yourself. You will not believe the mental and emotional freedom that comes with being sober.

Some people find the “disease” model of addiction or alcoholism helpful. Others do not. You can decide. I like it, as do many of the people I work with in therapy, because it tends to reduce shame or stigma.

In other words, try not to be hard on yourself for having this problem. There are a lot of successful, even famous, people in recovery meetings here in Los Angeles. In a sense, you’re in good company.

Don’t worry about why you drink, either. That becomes clearer with time. I think of it this way: an emotionally wounded or abused person seeks relief from alcohol, and then alcohol begins to abuse the person. It often repeats the earlier cycle of dysfunction and emotional turmoil with eerie accuracy.

Now, to your question of “what next?” Again, no right answer. Your best bet is to check out different recovery meetings and call or visit rehabs. The point is to get into the habit of not drinking.

You may not find the perfect meetings or rehab. It doesn’t matter. It just has to be good enough. Emotional sobriety holds that we “not let the good be the enemy of the best.” Early sobriety is different in that we ought “not let the best be the enemy of the sober.”

You may not find the perfect meetings or rehab. It doesn’t matter. It just has to be good enough. Emotional sobriety holds that we “not let the good be the enemy of the best.” Early sobriety is different in that we ought “not let the best be the enemy of the sober.”

You may like 12-step, or you may prefer something more secular such as Rational Recovery or Smart Recovery. Smart Recovery is more practical-minded than Alcoholics Anonymous (AA) and does not lean as much on the spiritual concepts found in AA, which some people find off-putting. You may want to experiment. There is no straight line outside of learning to live without the bottle. (Bottles are but a symptom, it says in the AA literature.) Have an open mind, find a meeting where you feel welcome, and try a couple more.

It may be hard to tell, should you find yourself dissatisfied, if this is true dissatisfaction or fear of staying sober or the booze talking. Experience will answer, but again, the only “mistake” is to give up. Early sobriety can be a roller-coaster, which is why I suggest your sobriety include the following elements:

  • A medical checkup. Medical guidance for detox is important. Some programs have detox on site, while others have detox centers that then transfer you to the on-site rehab program.
  • A psychiatric evaluation. Ideally, this is done by someone experienced with alcoholism. You’ll want someone cautious—neither strict nor “pill happy.” Some medications are safer than others. Some people may need antidepressants in the beginning, others do not. There is no formula when it comes to this, nor is there shame in needing medication, if that’s what a doctor prescribes. Again, as long as you’re not drinking, you’re on the right track. A psychiatrist who is flexible but understands addiction is key.
  • Social support. Whether it is in recovery meetings or an outpatient or inpatient program, social support is crucial. Alcoholism thrives in isolation. You will know in your heart when you have found the right group of sober people, but don’t give up if it doesn’t happen right away. Keep seeking and you’ll find it.

Finally, I recommend, should there be any issues with anxiety, depression, and so forth:

  • Counseling or addiction therapy. This can happen right away or after you get used to not drinking. I am of the belief, being a therapist, that having at least a handful of sessions with an experienced counselor is helpful. There are reasons we drink, and stopping can be traumatic. It can feel like losing a loved one, strange as it sounds, or a rocky divorce, even if separation was long overdue.

People recovering from alcoholism tend to have strong opinions. You may hear a lot of non-professional suggestions, which I suggest you take with a grain of salt if they are all-or-nothing, black-and-white. For instance, “Stay away from therapy, it’s all BS,” or, “You don’t need medication if you’re depressed, we’re ALL depressed,” or, “If you’re not going to 14 meetings a week, forget it,” or, “You must read the Bible to stay sober.” Nothing is black and white—except, well, you guessed it. Just keep your feet in motion.

Having said all that, the majority of people in recovery will likely be encouraging and helpful; in fact, helping newcomers is a pillar of AA recovery. Personal experience counts a lot. If you meet someone you would like to emulate, or you feel you relate to, you can ask what has worked for them and try that.

A quick word about rehab clinics and facilities. I would visit them in person, if possible. Some take insurance, some don’t. The better ones will contact your insurance company for you (if applicable) and see what benefits might be available. You might want a rehab that offers something besides 12-step recovery. For instance, you might want therapeutic help with anxiety/depression, workplace issues, family problems, and relationship issues.

Key questions in checking out rehab or outpatient programs: How long have they been in business? Can you visit or tour the facility? Is there an alumni network to make use of after treatment ends? What is the discharge planning process? Is it 30 days, then over and out, or are you referred to aftercare treatment, as in local therapists or psychiatrists or alumni groups? What is a typical day or evening like in the program? Is it structured or is there quite a bit of downtime? What is the age range of the population?

I would be wary, unless you are in truly dire straits (i.e., in medical or psychiatric crisis, in which case a visit to the emergency room may be needed), of getting a hard sell from any particular place. The right facility will invite you to visit and be hospitable. Avoid any facility overly anxious to fill a bed.

Once there, what vibe do you get? Does the staff seem happy to be there? Are the counselors fully licensed (at least on a master’s level) or are they interns? If there is an alumni community, could you talk to one or two of the “graduates” to get their take?

Go forth and discover. I would at least try some AA meetings because there is a lot of wisdom and experience in those rooms. Just remember recovery is not necessarily religion, you don’t have to be an AA “fanatic” for it to work, and you may need more meetings in the beginning than later. In sobriety, one sees that the only real constant in life is change.

Thanks again for writing.

Best wishes,

Darren Haber, PsyD, MFT

Darren Haber, PsyD, MFT is a psychotherapist specializing in treating alcoholism and drug addiction as well as co-occurring issues such as anxiety, depression, relationship concerns, secondary addictions (especially sex addiction), and trauma (both single-incident and repetitive). He works in a variety of modalities, primarily cognitive behavioral, spiritual/recovery-based, and psychodynamic. He is certified in eye movement desensitization and reprocessing (EMDR) therapy, and continues to receive psychodynamic training in treating relational trauma, including emotional abuse/neglect and physical and sexual abuse.
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  • Iressef

    April 18th, 2018 at 2:36 PM

    I beg to differ having experienced in my own family but that”s a very subjective and delicate issue. I actually know many people who just couldn”t handle the 12 step an other conventional programs and followed different paths with more or less success but some of them actually are now “manageable messes or functional addicts, specially if living in contexts where total sobriety is nearly impossible. Hollywood is one of those early impossible environments for addicts, it requires a special kind of strength to live there and maintain sobriety.

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