What to look for in alcohol treatment (and why it matters)

I will describe an ideal situation for alcohol treatment. I hope you can find it.

Why does it matter? People seeking treatment have usually tried to change on their own but have not made enough progress, or they are responding to a crisis (a DUI, liver failure, or your partner walking out). If you are seeking treatment under these conditions, you may not feel confident in yourself or your decisions. To move forward well, it will be easier to enter treatment that, among other things, works to build you back up. You will face many decisions during the process of change and will need to build confidence in yourself.

Treatment Should Work With You, Not On You

One of MM’s great strengths is that it does not tell you to abstain or moderate. You make your own decisions. Unfortunately, many treatment centers fail in this regard. Ultimately, you will do what you want to do, so treatment centers need to acknowledge this fact. A good facility acknowledges this and works with your values, situation, and goals, rather than overriding them.

That said, an initial period of abstinence has real merit. From a learning perspective, longer is better. If asked (sometimes I do get asked…), I typically recommend 90 days. Ninety days is long enough to significantly reorient your life. Even if you return to drinking after that period, you’re less likely to return to heavy drinking. However, the choice of any period of abstinence should be yours.

If you enter detox or residential treatment, you will be entering an abstinence-only scenario, which is reasonable for the facility. You do not need to attend the facility if you object.

What Good Residential Treatment Looks Like

For residential treatment, ideally you get:

• Nutritious food and time to exercise or walk
• As many individual sessions as possible so you can address your concerns (which might include depression, anxiety, trauma, bipolar disorder, as well as other substances)
• Groups built around open discussion, not lectures
• Open discussion about how you might moderate at some later point
• A focus on how to cope with cravings
• Enough time to socialize with other residents and engage in “normal” activities, like going to a movie or eating out together.
• Visits from family, access to your digital devices, and contact the outside world if you desire them.

If you believe you need a dramatic, extended retreat from the world and to be placed on a treatment plan decided upon by the provider, those facilities exist.

What to Expect from Outpatient Treatment

Outpatient treatment—whether you go straight there or transition from residential treatment—should give you some control over your schedule, especially how you taper off contact as treatment winds down. Many people underestimate how long that process should take. Monthly sessions should continue for many months, then drop to quarterly before stopping entirely.

Everything I said about residential treatment applies here too.

Other Pieces of the Puzzle

There are other potential components of alcohol treatment, including medications and the providers who prescribe them, sober living homes, recovery coaches, holistic healers, and others. I suggest approaching all of them from this perspective of looking for others who will help you build confidence.

No one knows your situation, goals, values, and strengths better than you do. You can still benefit from others’ suggestions, but look for providers who want to work with you, not against you. You have been successful in other aspects of your life. Find a provider who can help you bring that success over to this project as well.

About the Author

Tom Horvath, PhD, ABPP, is a board-certified clinical psychologist and the founder and president of Practical Recovery, a self-empowering addiction treatment system based in San Diego. He is a past president of SMART Recovery, the largest non-12-step mutual help network in the world, and past president of the American Psychological Association’s Society of Addiction Psychology. He is the author of Sex, Drugs, Gambling & Chocolate: A Workbook for Overcoming Addictions and has spent four decades helping people build the confidence and clarity to change on their own terms.

Ready to explore your options? Moderation Management offers tools, meetings, and a supportive community for people navigating their relationship with alcohol on their own terms—no one-size-fits-all program required.