Dear Dr. Josh: Do I Need Rehab?


Dr. Josh Lichtman, answers your medical (and occasionally spiritual) questions.
First up: letting an alcoholic know if rehab is necessary…

Dear Dr. Josh:

There is no doubt in my mind that I am a pretty severe alcoholic. Do I need to go to treatment, or can I just get sober on my own? – On the Fence

Dear Fence,

You need to go to treatment. You probably are reading this and think that this is just a knee jerk response from a dude in a white coat. It truly is not. Yes, I know people who have gotten sober without formal treatment, and I have also seen plenty of patients who can’t get sober despite great treatment. Ultimately, the only way anyone gets clean is if he or she really wants to get clean. My point is this: there is no such thing as half-way sober; the only way to get clean is to be all in. Good treatment will provide you with the safe and supported container that will make getting and staying sober much easier.

Most treatment starts with a medical detox for certain substances, depending on the severity of the problem. The withdrawal from some substances, including alcohol and benzodiazepines (Xanax, Ativan, Valium, Klonopin, etc.), can actually be life threatening if not treated appropriately. These situations require a medical detox with close monitoring and medication. Other drugs—opioids, crystal meth and cocaine—do not have life threatening withdrawal symptoms but can still leave a person feeling awful while the body kicks it. This can be alleviated with a detox that not only includes medications to treat withdrawal symptoms but also the possibility of using other medications to smoothly taper the body off opioids, such as Suboxone. Honestly, detox isn’t as bad as you may imagine; it is just a physiological process. One of the most recent alcoholics I detoxed told me that he felt guilty because it wasn’t painful at all for him. He likened it to camp but without S’mores or popsicles.

Once you’re medically stable, you engage in the meat of treatment (or for the vegans out there, the meat alternative?). This usually involves intensive group therapy, process groups and instructional groups like relapse prevention. If you’re thinking, “Now hold it there, Mr. Doctor, I’m not into sharing my feelings with a bunch of strangers,” just know that group therapy is the best method I know for showing people that there are other people just like them. Also, there will inevitably be at least one person in the group who is way more screwed up than you, and this may make you feel better (unless, of course, you are that person).

If your treatment includes psychotherapy, it could be trauma therapy, cognitive behavioral therapy (CBT), supportive therapy, psychodynamic therapy, EMDR, DBT or lots of other acronyms. Honestly, there isn’t enough space in this magazine to discuss them all. We’ll leave that to future columns. Psychiatry will probably also be a part of treatment; this is where a physician will interview you and determine whether or not medications such as SSRI’s or mood stabilizers may be helpful. There are also usually case managers and counselors on hand to help with the practical parts of getting your life back on track.

Several programs include other therapeutic modalities like meditation, yoga, art therapy, family therapy and even surfing, writing, sweat lodges and paintball (yep, paintball).

All of this can be done on an outpatient basis, where you can live at home, or in a sober living house, but residential treatment is highly recommended. I hope you find the right program for you. I recommend checking the InRecovery directory for options. Hey, if you find a place that provides S’mores, let me know. I think a number of my patients would like that.


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