IWNDWYT - Stop Drinking Start Living

Mike Jacobsen

Medically Detoxing from Alcohol

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When I first tried going sober I did the whole cold turkey thing. I relied solely on over-the-counter medications to get me through the sweats, the shakes, the headaches, the vomiting and all the rest of it.

It was not fun at all.

Also it was really dangerous. I only learned afterward that withdrawing from alcohol cold turkey like that can have some serious long term impacts to your health. And can even result in death.

That is why now whenever I am asked what the best way to do detox is – either here or in my role as a counselor – I say that the best way is the way that your Doctor advises.

A medically supervised detox will be far easier on your body than just quitting cold turkey. With easier in this case translating to safer. It also means more likely to stick. In my experience people who detox under the care of a medical profession are many many more times likely to succeed than going it alone.

What is the Detox Process?

Detox is when your body gets rid of all the remaining alcohol that is going through your system. It is not so much the getting rid of the alcohol that is the problem – that is a good thing! – it is how the body comes to adjust to not having alcohol present any longer.

Just think about it. Your body will have adjusted to the presence of alcohol for so long that it has come to rely on the fact that it will be there. Chemical processes all across your body have to account for the fact that alcohol will be present. Then all of a sudden there’s no alcohol anymore and these processes are still working as though there is. It takes time for the body to update to the lack of alcohol and during that time you will experience some symptoms.

The symptoms from detox can last anywhere from a few days to a few months. These can range from a mild hangover all the way through to seizures and even death.

Due to these risks medically assisted detox is the go to recommendation for those people who have been drinking for a prolonged period of time.

Why is Medically Assisted Detox Necessary?

A good video recap of the why’s of detoxing

Alcohol is one of the most dangerous substances that one can detox from. I would say it is probably the most dangerous substance to experience withdrawals from that can be legally purchased in most parts of the world.

Withdrawing from alcohol is known to provoke the following symptoms

  • Increased and erratic heart beat
  • Fever
  • Hallucinations
  • Anxiety
  • Sweating
  • Increased blood pressure
  • Confusion
  • Headaches
  • Feelings of nausea
  • Tremors
  • Seizures

Seizures are the most serious of the above symptoms and occur because your brain has become so accustomed to the presence of alcohol that when it is removed it can no longer function correctly.

It really is a kind of perverse catch-22. You have to stop drinking because the alcohol is poisoning your body and killing you slowly. But the act of quitting has the potential to kill you quickly.

You might think that tapering is the answer, whereby you reduce your intake over a course of days until you are not drinking at all. But that comes with it’s own issues – namely if we were able to control how much we drank we wouldn’t be in this situation in the first place.

That’s why medical detox is necessary.

What medications are prescribed during detox

YOU SHOULD ALWAYS CONSULT YOUR DOCTOR BEFORE EMBARKING ON ANY DETOX PROGRAM

What is prescribed during detox will vary from person to person but the most commonly prescribed medications are:

  • Benzodiazepines to treat the symptoms of alcohol withdrawal (most importantly to reduce the frequency and severity of any seizures).
  • Anti-nausea medications
  • Vitamins (to prevent Wernicke Syndrome)
  • Anti-convulsants
  • General pain medication
  • Anti-cravings medication (such as naltrexone) normally prescribed once the withdrawal process is complete
  • Anti-psychotics

Care needs to be taken when taking any medications as there is always the risk of developing a cross dependence, particularly in the case of benzodiazepines. You should always be completely forthright with your Doctors during treatment so that they can prescribe the correct medications based on your medical history.

What happens after detox

After detox is when you learn to live in a post-alcohol world. For some people this would be a short stay in a treatment facility. For others an out-patient program can provide them with what they need to remain sober in the long term.

Some people might be able to keep up their sobriety with meetings alone.

What ever you decide is right for you just make sure that you do something. Going back to the same life as before without making any changes is one of the surest ways of triggering a relapse.

Write a Letter to Future-You

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Going sober is never easy. I know I failed a couple of times at first and I expect that holds true for a lot of people.

People think that once you get over the first few days that things get easy. And while it’s true that physically things get easier with time I would never call it easy – there are still mental challenges all the way.

A big thing to always be aware of is complacency and/or forgetfulness. You go so long without a beer that you start to forget just how bad your drinking was. You forget the issues it caused or you downplay the impacts they had to your life – to your health, your relationships and your wallet. After a while this thinking leads to thoughts like:

“Just a few drinks won’t hurt”

or

“I wasn’t that bad before so I won’t be that bad now”

The mind has a great way of making you forget just how bad things were. The longer you go without a drink the more you truly start to believe these things.

That is why I recommend that everyone writes themselves a letter. A letter from you now to you in the future (future-you). This letter should serve to remind future-you of the pains that alcohol brought into your life and detail the reasons why it would be unwise to go back to how you once were.

With that in mind here are some tips for how to write your own letter to your future self. Hopefully these help you to compose a letter that stops future you from relapsing.

Read this letter

https://www.soberrecovery.com/forums/newcomers-recovery/352422-letter-my-future-self.html

This is a really fantastic letter that someone going by the username Mrrryah1 writes to their future self. In fact it was this very letter that made me write my own letter back when I first got sober.

Don’t sweat the grammar

You aren’t trying to get a passing grade in English Lit. This letter is just for yourself to read. Feel free to skip a comma or two.

Don’t sugar-coat anything

There’s no point in lying to yourself. In fact you want to be completely open and honest with yourself here. You need to remind future-you why they are sober in the first place.

In the future when you are reading this letter you may have forgotten or downplayed how you were feeling and what you were experiencing.

That’s why when you write this letter you need to be explicit in how drinking was affecting your life

Do include examples

Get specific in your letter.

“You spent a lot of money on drinking”

When you read that in the future it might not mean much to you. Like sure you probably spent some money; but how bad could it have been really!?

“In November 20XX you spent your entire paycheck in one day when you went to the bar and didn’t go home for 2 days”

Now that is specific. And I am sure we all have some specific tale we can tell. Whether it be how drinking affected our finances, our health or our relationships with others:

“You got out of breath trying to carry your kids to bed”
“You missed your anniversary dinner because you were in the pub”

Try and include as many of these as you can.

Show empathy

Even though this is you talking to future-you the letter still needs to show empathy. You need to appreciate that future-you will be reading this letter and might not be in a good space.

You need to therefore convey that you appreciate that they are currently in a difficult place but that they need to stick with it as it cannot be worse than the alternative.

Be direct

Empathy can only get you so far. Sometimes you need to be forceful to get your point across

“If you start drinking again you are going to die” – not a death threat!

The letter I wrote to myself actually calls me a dickhead. In hindsight this probably wasn’t the best thing to write as when I read it now I feel a bit aggrieved at past-me – ‘I’m trying my best why am I being so mean to myself’. Kind of makes me want to drink a little just to spite him. But I don’t.

But in fairness to past-me if I started drinking again I would be a bit of a dickhead so maybe he’s right.

So be understanding but also be firm. You are aware things might be difficult but under no circumstances is drinking again going to be the answer.

Share your letter

Once you’ve written your letter share it with those close to you. Could be your sponsor, or your partner. Or even just your close friend.

They will be able to read it from a fresh perspective and might be able to give you advice on things to include that will resonate with future-you

Sometimes those closest to us actually know us better than ourselves

Add to it every now and then

This isn’t a formal letter you are writing here. So it doesn’t really make a difference if you think of something later on and decide to tack on a P.S or a P.P.S or even a P.P.P.S. If you think it will help keep adding more and more.

Write a book for yourself if that’s what it takes.

Maybe a little too much

Keep it close by

Once the letter is done and you are happy with its contents then keep it somewhere safe.

You want to be able to read it whenever you feel yourself slipping.

I keep mine alongside my relapse prevention plan and I read it whenever I have those nagging thoughts about drinking.

Have you written a letter to yourself? Share your thoughts in the comments below. We’d love to hear them.

Inpatient vs Outpatient – What Type of Rehab is Best for You?

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So you’ve decided that the best thing for your sobriety is a trip to rehab. That is a great first step and you should be proud that you have taken it. Now the next step is deciding which type of rehab is best suited for you.

Everyone is different. What works for me might not work for you.

I do always recommend that everyone take a long look at inpatient facilities in the first instance. I believe – and the statistics back me up – that inpatient facilities provide the best care and give you the highest chance of remaining sober long term.

But inpatient facilities are not for everyone. Whether its the cost, the time away from home or something else not everyone can use inpatient facilities. That is why outpatient programs are so popular.

Inpatient or outpatient. That is what we are going to look at it in this post.

Video overview

Here’s a really high level look at the differences between the two in this video

Inpatient

Inpatient rehab is when you stay and live in the rehab facility full time. Living at the facility helps you avoid any temptation or negative influences you may have in your day to day life. Inpatient programs are able to offer 24/7 support and care. Programs typically last between 4 and 6 weeks but there are long term programs available that can take you in for 6 or even 12 months.

Daily life during rehab

Your schedule is pretty rigid when you are in rehab. You will have set times for waking up, going to bed, meetings, group time, therapy sessions, rec time etc.

Here is what my friend Joe wrote when he described his rehab experience for us:

“The schedule in this place was pretty rigid. Kind of like what I imagine prison to be like.

Wake up, Breakfast, Group session, Therapy, Lunch, Group session, AA or NA meeting, Dinner, Group session, Free time, Lights out.

That was the general gist of it. As I say it was pretty rigid and your personal schedule was shared with you every Sunday for the next week. One-on-One Therapy if you were having it would slot in somewhere and you would have to stop whatever you were doing to attend.”

Things to consider

Inpatient programs provide 24 hour care. You are never really alone from the moment you check in to the moment you leave. This would be particularly helpful for those of you who believe they need to be looked in on in order to not slip.

Inpatient programs often cater for a number of different issues. This is useful if alcohol abuse isn’t the only issue you need help with. Any underlying mental health conditions are more likely to be treated when doing an inpatient program.

Treatment schedules are pretty rigid. Like Joe said before it could be described as “prison-esque” in how strict the demands are. Maybe this is good for you or maybe this will be difficult. It really depends on your personality and how you cope when giving up control.

There is no leaving once you are in. (Well you can if you want, it’s not actually prison!) Leaving the facility is walking out on the program so to stay with the program you are required to remain in the facility grounds the whole time – unless advised otherwise by your carers. This means that any family or personal obligations need to be taken care of before you go in or else they will not get done.

Costs. Living in a facility like this with 24 hour care does not come cheap. Not just the payment for the care itself, if applicable, but also for the time you need to spend off work in order to devote 24 hours a day to treatment.

Outpatient

Outpatient rehab usually involves daily treatment. Either in the form of medication, therapy, counseling or group sessions. Outpatient is usually a lot less restrictive. Once you are done with any treatments you can go. You are not expected to remain in the facility and will be sleeping at home in your own bed.

Most programs follow a “ramp up – wind down” approach. This means that treatments will be intense to begin with (ramp up) but will become less and less intensive until they finally cease (wind down).

Things to consider about an outpatient program

Treatments can be scheduled around your commitments. A lot of programs will offer evening or weekend treatments. This could be good for those of you working a 9 to 5 where you don’t think you could get the time off.

You can live at home while taking part. This is good if you have a support network at home that can take care of you outside of your treatments.

Costs. Outpatient programs are usually much cheaper than inpatient programs.

Outpatient programs might not be suitable if you:

  • Experience constant urges that you are unable to overcome.
  • You have a history of not committing to treatment programs
  • You need treatment for alcohol abuse AND an underlying mental health condition or co-occurring dependency disorder.
A visual representation of the differences between inpatient and outpatient facilities

In the end the decision is yours and yours alone. Different programs appeal to different people and only you can know which one is right for you.

Have you been to rehab before? If you are open to it please share in the comments below. Your experiences may help someone else get sober!

How to Choose the Right Rehab Center for You

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So you have admitted to yourself that you have a drinking problem. You have weighed up your options on how you want to quit and you have decided that a rehab center is the right fit for you.

Getting to this stage is a great achievement and you should be proud of yourself for admitting you have a problem and seeking help.

Now there’s just one last thing for you to do. Decide which rehab center is right for you.

There are over 500 treatment facilities in the UK and an estimated 15000 centers in the US. So you really are spoiled for choice.

That’s why in this post I am going to be going through all of the different options so that you can make the right choice for you.

Disclaimer: While I do live a sober life and did formerly have a drinking problem I did not actually go to rehab to sober up. I detoxed at home. Something that I would only recommend as an absolute last resort when rehab is not an option. And only after discussing with a trained medical professional. I have done a lot of research into this field and through my volunteer work have actually helped numerous people find placements in rehab. So while I have not actually stayed in a rehab center you can rest assured that the below is accurate and helpful. Having said that just to be sure I asked my friend Joe (who wrote a previous post about his experience with rehab) to edit and to add his thoughts. Any callouts he wishes to make will look like this:

Joe: Hi!

With that out the way lets dive into how to pick a rehab center

What do you hope to achieve

Every rehab is different and will specialize in different things. The first step you need to take is to decide what it is you want to get out of rehab. Do you just want to detox, do you want to “dry out” for a month or more, do you want help for any underlying mental issues you may be suffering from that contributes to your drinking disorder?

When you know what your goal is you will be able to better match up with a rehab center.

Joe: When I was thinking about going to rehab I wanted a place where I could detox from the booze and then stay for a few more weeks to get to terms with sobriety before “rejoining the world”.

What type of facility is best for you

Onsite Detox

Some facilities have their own detox programs. This is where they medically assist you as you come off of the booze. Other facilities will expect you to have gone through this already before joining the rehab.

Joe: The facility I went to had their own detox center. It wasn’t up to much if I’m honest. The detox takes a few days and is generally the hardest part of the process so looking back I wish I had found a place with a better detox program.

Inpatient vs Outpatient

The two major forms of organised rehab. Inpatient is when you check into a rehab facility and stay there throughout the program. Outpatient programs typically have you come in through the day for treatment and therapy and then you leave and stay in your own home the rest of the time.

Joe: I was told that inpatient treatments have a higher success rate but are often pricier or have longer wait lists for a bed.

Specialities

A lot of centers will not just be for alcohol recovery. They will also intake people who have problems with drugs, or other types of addiction such as porn addiction or eating disorders. If you have multiple issues you are looking for help with then some of these centers might be for you. Otherwise you might wish to look for centers that either only take people with alcohol disorders or who have a focus on alcohol.

Treatment/Therapy styles

There are a number of different treatment types and different therapy styles that are in use in rehab centers. The main ones are:

Cognitive Behavioural Therapy
12 Step Programs (Alcoholics Anonymous)
Biofeedback Therapy
Dialectical Behavior Therapy
Holistic Therapy
Psychodynamic Therapy

You should inquire about what therapies and counselling are offered in the rehabs you look into and see if they are right for you.

Program Length

How long is a piece of string?

Rehab programs can be anything from a few day detox all the way upto a few month long inpatient treatment with a lengthy stay in a sober house and continued outpatient treatment.

So basically anywhere between 3 days and forever.

When you are looking into rehab centers inquire about how long their normal “stay” is. Ask what the usual follow up treatment process looks like. Some places may advertise a high success rate but that might only be for patients who complete a much longer stay than you are able to do.

Joe: I chose to do a 28 day before I had even detoxed. My thinking process at the time was that it would take a week to get the alcohol out of my system and then I could take 3 weeks to get used to it before I went back out. I feel this was a good length of time. I don’t think I would have got much more benefit out of staying any longer.

Location

Nearby facilties will be the first place you look. Purely for convenience factor. A lot of people, however, will recommend that you go far away for rehab as it completely disconnects your brain from your former drunk life.

Joe: The place I went to was about 2 hours out of my city. I thought this struck a nice balance between convenience in being local but was also far enough away that there was nothing around that would remind me of people or places that I associated with drinking.

Cost

Probably the biggest factor for most. It is true that rehab centers can be pretty pricey. And if they are free then you better believe there is going to be a long waiting list. When you are looking for centers check on their website for prices. A lot of centers will not share this information so you may need to call them up and see what it will cost you (or how long the current wait for a bed is). If you carry private insurance you should ask if the center is within network for you to be able to attend on your insurance.

Joe: I had to fight with my insurance company as they originally said they would only cover the detox portion of the treatment plan. After some back and forth I finally had the whole thing covered. I would recommend you speaking with your insurance company first and see if they have a list of centers that you can choose from.

Facility Amenities

Most centers try to keep you busy with meeting and therapies. But there are always shared group activities that they will encourage you to take part in. These will vary based on the particular facility you choose. Think pools, basketball courts, table tennis and so on. The recreational activities available probably shouldn’t be at the top of your list when deciding but it is something to keep in mind as you will likely have plenty of downtime if you choose an inpatient program.

Joe: My facility had a bunch of recreational activities available. They were rarely used by the residents however. The T.V room was always full and we had group basketball quite often. But I never saw anyone play table tennis the entire time I was there.

Family Involvement

Some facilities/treatment programs will restrict the contact you can have with friends and family. This is more likely to happen if it is believed that contact with these people will cause you to relapse.

Joe: We had phone privleges which could be withdrawn by our therapist. I was allowed to use the phone any time I wanted as my therapist didn’t believe my drinking would resurface through contact with my family. There was also visiting allowed a few days through the week. If you were to go further away from home in-person visiting would obviously be more difficult.

Talk to an addiction specialist

Now that you have a general idea of what you want to get out of rehab. It is time to speak with someone who can point you to rehab options. The first step should be to your GP or primary care physician. They should be able to put you in contact with an addiction specialist who will be able to provide you with your options.

Research your Options

Now that you have a list of options, that hopefully match your preferences for cost, location and all the other factors talked about before, it is time to whittle that list down to 1.

Look at the website – Does the website confirm that the center has everything that you are looking for? If you have been told the center offers a specific treatment type check this is confirmed on their website.


Look at any reviews online – What do past patients have to say about the center? Try a google search “Center Name + Review”. Also look at any social media profiles the center may have setup.


Look at any accreditations – What qualification do the members of staff hold? Also look into the qualifications themselves. Not all accreditations are equal.

Reach out to the center for more information – Have any other questions? Just give the center a call. Most will be eager to talk to prospective patients.

Enroll

Once you have chosen the center for you all that is left is to enroll.

Joe: Don’t overthink things. Pick a center that feels right and get in there.

My Experience with Rehab

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Note from Mike: this post comes from a friend of mine, Joe. Joe and I first met in a meeting when I was visiting the States a number of years ago. When I told him more recently about this site and how I was sharing my experiences here he asked if he could share also. If you too would like to share your experiences please get in touch. Joe is going to talk about his experience going to a rehab clinic.

Intro

When I was first thinking about getting sober I turned to the internet to see other people’s experiences…I had not yet built up the courage to go to my first meeting at this time.

The stories I read online proved to be very helpful in making me decide to go sober AND in choosing to go to a rehab center. Sorry not rehab, the place I went to preferred to be called a “Wellness & Recovery” center. But you know. Exactly the same thing just a different name.

At the time I was in my late 20s, had a fairly decent job that allowed for a lot of time working from home. I had a house and a wife. I also had a pretty heavy drinking problem. Most days I was putting away a standard size bottle of vodka. Sometimes more, but not often less.

Most mornings started with me vomiting and feeling just shitty. That is until the first couple of drinks had settled me down a bit.

Even with all this I remained quite “functional”. I still kept up with what I needed to in work. I wasn’t a model employee but my tasks got done. Working from home allowed me to hide the true extent of my drinking from all of my colleagues.

Eventually though enough was enough and I finally admitted to myself that I needed help. I needed treatment.

Looking for facilities

This was relatively easy I must admit. I went to my family physician who luckily had lots of experience in this area. Within a few days I was sitting down getting evaluated…the result of which would be a recommendation for inpatient treatment.

After some back and forth with my insurance company…they are never easy to deal with…I settled on a 28 day stay in a facility about 2 hours out of my city.

Checking into this facility was less than glamourous I must say. First all my belongings were tossed through. Then I was given a very thorough pat down…just to be sure I wasn’t hiding a handle of vodka down my pants or something.

The facility

The place itself was quite nice…not Hollywood starlet rehab clinic nice, but nice enough. There was a few recreational activities like table tennis, basketball and pool. There was also a T.V room that was always full regardless of what was being shown. Most of my downtime was spent reading. Luckily the facility had a wide selection of books as I stupidly forgot to bring my kindle or any books of my own.

The treatment

For the first few days I had to remain in the “Detox Chamber”…seriously thats what the official name was.

In here there wasn’t much in the way of activities. Just a TV really and books. This is where I spent the next 4 days while I detoxed off of alcohol. The staff gave me a number of medications to help me through it. There was pills to prevent seizures, pills for lowering my blood pressure, pills to help me sleep, pills to ease the cravings.

After this I was allowed free rein of the facility. Which is what I did in my downtime.

The schedule in this place was pretty rigid. Kind of like what I imagine prison to be like.

Wake up, Breakfast, Group session, Therapy, Lunch, Group session, AA or NA meeting, Dinner, Group session, Free time, Lights out.

That was the general gist of it. As I say it was pretty rigid and your personal schedule was shared with you every Sunday for the next week. One-on-One Therapy if you were having it would slot in somewhere and you would have to stop whatever you were doing to attend.

Most of the group sessions were pointless and merely an exercise in keeping us busy. Some had merit though. I learned how to correctly process my emotions to avoid getting worked up or overly emotional, which I figured was one of my triggers.

I was also allowed unlimited use of the phones. Which I believe I was only one of the few that was allowed that access. Most people were given limited access as part of their treatment. I was allowed unlimited as my therapist didn’t believe me communicating with my friends and family would put my treatment in jeopardy.

Fellow patients

During the first few days in detox I had a chance to meet my fellow patients. Mostly they seemed to be around my age or younger. Everyone is generally supportive. A lot of people seemed rather non-plussed by the whole experience and I got the impression that checking in wasn’t exactly their choice. They were being told to go by parents who still held the purse strings. Which again surprised me since the place was nice but not trustfund kid nice. But anyway I didn’t pry so I don’t know what the full story was only the pieces I heard throughout my stay.

I got to know a lot of the patients, but not really in-depth. Making new friends wasn’t part of my recovery plan so I just generally kept to myself and “did my time”

Staff

The staff was perfectly friendly at all times. The therapists were good and seemed knowledgeable. Nothing really to mention here. It was really what you would expect from professional medical personnel.

Post-rehab world

When you get out you are really happy to see other people. And to eat other food. I should stop comparing it to prison because you are free to leave at any time and it was only 28 days…but that is how it feels.

At the advice of my therapist when I returned home I got a new therapist who is closer than the one at the center and I also started to attend weekly meetings…which is where I met Mike.

After a few months I stopped seeing my therapist as I believed the meetings would be enough to sustain my soberness.

In General

Overall I would say my experience was positive since afterward I came out sober and have remained sober since. I feel though I maybe didn’t need to actually be holed up there for the full 28 days. That maybe a detox program followed by daily therapy/meetings would have sufficed. Particularly since the downtime is so boring.

But then again I did it this way and it worked so why question it.

Note from Mike: I just want to thank Joe for sharing his thoughts with us today and also to tell everyone reading that if you have any questions for Joe about rehab please feel free to ask in the comments section below and I will make sure that Joe sees them.