Alcohol Rehab

What Staff Does a Rehab Have ?

A rehab or treatment center should employ a wide range of different health care professionals, who have extensive clinical experience in dealing with alcoholism and addiction.

If the rehab is basing some of its therapeutic treatments on the twelve step progarm of Alcoholics Anonymous, then it is usually helpful if some of the staff are in recovery themselves, often having been in rehab themselves at some point.

This assessment of clinical staffing levels should relate to number of staff, different disciplines, qualifications and experience.

This information should be available on the rehab’s website, along with inforemation about availability of medical staff (should be 24/7) and regularity of therapy / conselling sessions etc.

Below is a list of the main types of clinical and therapeutic staff normally employed in a rehab. In addition a rehab should employ a number of well trained admin staff who can help the client through the often complicated admissions and insurance verification process.

Medical Doctor
Nurses
Psychiatrist
Psychologist
Therapists / Counsellors
Yoga Teachers
Chi Kung / Tai Chi Teachers
Reflexology Practitioners
Acupuncture Practitioners
Art Therapy Practitioners
Meditation / Mindfulness Practitioners
Dietitions
Nutritionists
Shiatsu Practitioners
Social Worker
Transitional Living Worker
Spiritual Guides
Fitness Instructors

What is Emotional Sobriety ?

Emotional Sobriety is the title of an article written in the journal of Alcoholics Anonymous, known as the AA Grapevine, by one of its co-founders Bill W.

In the article, he writes at length about the need to address many of the underlying emotional drives that fuelled his alcoholism, and implied that this was in effect a stage that follows the initial phase of getting sober and staying sober.

Many people have interpreted this as meaning different things. Emotional sobriety is often used as a form of judgement as to how ‘well’ people are in sobriety, irrespective of how long they have been sober.

Other people will often compare what they call physical sobriety with emotional sobriety, implying that once physically sober the level with which people are able to adapt and integrate their lives into sobriety indicates a degree of wellness.

It is really important, to understand the thinking behind the term emotional sobriety, irrespective of how long anyone has been sober or not.

Firstly sobriety is about being sober, pure and simple. There are no degrees of it, there is no judgement about it in terms of wellness or not, or how well people cope with it or do not manage to.

Emotional Sobriety

Emotional sobriety should be thought of much more in terms of the underlying emotional drives that play a part in most people’s alcoholism.

Anyone getting sober, whether in a rehab or through a 12 step program or some other way, will soon begin to realise that once sober the real issue becomes how do people stay sober, whilst living with the emotional turmoil that most people feel is inside them.

The process of people understanding and making sense of their alcoholism is a really important one.

What is equally important is that they have the freedom to discover for themselves what this understanding and connection is between alcohol and their emotional states.

Most people would recognise that their alcoholism is a mix of an instinctive or instinctual need to drink, and the sense of relief or freedom that alcohol gives them once they have taken a drink or several.

Often this connection between the effect of alcohol and what it is affecting you within is only clear at a felt level. Once sober, it becomes clearer that the emotional states such as anger, fear, loneliness etc that are a common part of alcoholism play a major role as a trigger for the compulsion or obsession to drink.

Emotional Sobriety and AA

However people come to understand their emotional states, it is normally clear from early on either in rehab or in meetings of Alcoholics Anonymous that the main type of therapeutic/spiritual work that needs to be done, is on helping the individual stabilise their inner world, and as such prevent the reflex action of picking up a drink or feeling the need to have a drink.

This work on one’s inner world, on helping to stabilise one’s emotions and begin the process of feeling relatively at peace with oneself at some level begins the moment an individual gets sober, either in a rehab or in meetings of Alcoholics Anonymous. This is the real focus of emotional sobriety, the understanding and need to be at peace with yourself.

What is a dual diagnosis?

Dual diagnosis is a term that specifically refers to people who would consider themselves both alcoholics and drug addicts, or people who have had problems with both alcohol and drugs. The term arose mainly in rehabs and treatment centers, and it is important to understand this context.

Initially treatment centers and rehabs treated people who had a problem with alcohol, whether they were turned alcoholics or problem drinkers, or people who had alcohol abuse issues. As this industry grew, people entered rehab who not only had problems with alcohol but with other substances including many narcotic drugs, and various behaviours.

Treatment centers and rehabs quickly picked up on this, and in the specific case of people who have problems with both alcohol and drugs they refer to them as being dual diagnosed. In addition, the rehab industry widened their scope of potential clients or a client base by beginning to define people as an addictive personality.

This meant that  in effect, any individual who had any addiction to any substance or any type of addictive behaviour could be labelled as an addictive personality, and  their particular addiction,  whether substance or behaviour, could be labelled their drug of choice.

Dual diagnosis

There are many people who believe that the terminology employed in the idea of an addictive personality and a drug of choice is simply to enhance the pool of people who can be susceptible to needing to go into treatment.

There are other people who defend the term addictive personality as being  a reasonably good definition of some help an individual who has a number of differing emotional drives and issues which fuel that alcoholism or addiction.

Whatever someone’s take on the term dual diagnosis, in reality it simply means that it refers to someone who has a problem but with alcohol and drugs, or has had a problem with alcohol and drugs and is now clean and sober.

In terms of 12 step recovery, what it really means is that individual will have used both alcohol and drugs at different stages of the alcoholism and addiction, and probably recognises a need to keep clear of both in order to stay clean and sober.

 

ALCOHOL WITHDRAWAL ADDICTION

Anyone entering a rehab for a problem with alcohol, commonly referred to as alcoholism or alcohol addiction would be well advised to be aware of the potential effects of alcohol withdrawal, sometimes referred to as a detox, historically referred to as the DT’s.

The effects of withdrawal from alcohol addiction or alcoholism can be severe in some people, and it is a good idea to make sure that anyone entering a rehab is clinically assessed,  by experienced clinical staff to  monitor the effects of withdrawal from alcohol.

One important aspect of alcoholism that is often not fully understood is that it is regarded commonly as what is termed a progressive illness.

There are sometimes a debate about whether alcoholism is a disease or an illness or a combination of nature or nurture, and people will have differing views on this question.

Too many  people who have got sober using Alcoholics Anonymous, they are very aware that her own alcoholism is a progressive illness, and for many it is the progressive element that is really important.

ALCOHOL WITHDRAWAL ADDICTION

The progression of alcoholism in many people is not simply a issue of tolerance for alcohol, it is a description of both how their drinking has progressed over a period of time, how that emotional state has changed during that time, and how alcohol has become at the end of the drinking the only thing of real value, the only thing that needs to be protected and kept safe.

One of the reasons this is so important, is in terms of understanding the nature of alcoholism, and in truth the only people who probably really do understand it either active alcoholics themselves, or people who have got sober and would consider themselves to be alcoholics in recovery.

The nature of alcoholism as an illness can be quite varied and widespread, the progression of it is an element that people who are alcoholics will at some level be able to identify with, either in terms of the  tolerance or lack of tolerance of their drinking, or a more general felt sense of their inner and outer world closing in on them, and alcohol remaining the only thing that is holding them together.

ALCOHOLIC TREATMENT

The nature of alcoholic treatment can be detailed in certain ways, but should always be fully understood that there are a number of variables that determine whether any form of addiction treatment programs will actually work or not.

Probably the most proven method of treatment for an alcoholic is effected through the  organisation Alcoholics Anonymous,  and its 12-step program of recovery.

There has also grown a huge industry of treatment centres and rehabs which offer a wide range of varying treatment programs for an alcoholic, normally residential, and normally for a period of around 28/30 days.

One of the main issues concerning any type of treatment for an alcoholic relates to what is commonly referred to as the self delusion of the alcoholic themselves.

This normally refers to the nature of an alcoholic themselves, in terms of emotional and mental character, and  the nature of how they relate to alcohol itself.

There are a number of different interpretations of what being an alcoholic means, and how alcoholism itself manifests within different people.

They are also a number of common features of alcoholism and alcoholics, which allow people to relate to each other at a particular level, and can help in terms of enabling people who are alcoholics to get a measure of stability and stay sober.

An alcoholic treatment program, whether it be in a rehab or treatment center, will need to address a number of highly sensitive areas, one of which will be the relationship between the alcoholic and alcohol itself.

ALCOHOLIC TREATMENT

It is probably fair to say, that at some point in their drinking, an alcoholic will come to see alcohol as being the solution to their problems, rather than the problem itself. This may happen at the beginning of their drinking, or maybe an element of the progressive nature of their drinking, Becoming the only type of reality they are able to understand towards the end.

This sense that alcohol becomes the only thing that is holding them together is perhaps unique to alcoholics, and is one of the hardest things for anyone outside of that circle to either understand or be able to deal with.

What is important, is that there is a safe environment created that allows an alcoholic to begin the process of feeling safe enough to dismantle the various emotional coping mechanisms that they have erected in order to keep themselves safe. This can include a variety of emotional survival  skills as well as the main coping mechanism, alcohol itself.

RECOVERY ALCOHOLISM

Recovery from alcoholism can in some ways be as difficult to understand at the nature of alcoholism itself when someone is drinking as a full-blown alcoholic.

This in part is because recovery from alcoholism for most people is not simply about stopping drinking.

Stopping drinking is an essential and crucial part of the process, but for many people who  intend to stay sober long-term, there is a real need to address and deal with a variety of underlying emotional and mental drives that have fuelled by drinking in the first place.

Many people will often talk about the issue of willpower in connection to either their drinking, that ability to stop drinking, and their ability to get sober or stay sober, or as a reference to an individual’s self will and the ability to seemingly force their life to happen.

Much of this can really refer to a distorted understanding of willpower, self well and alcoholism itself.

RECOVERY ALCOHOLISM

For anyone who is an active alcoholic, the issue of willpower often does not simply arise.

The reason for this, is that there are many alcoholics who simply do not wish to stop drinking, and never do or never try to.

This is not because they are oblivious to the reality of what their drinking is doing to them, but because the nature of that alcoholism in someway turns them in would, and makes them believe that however bad the lifers either internally or externally, alcohol becomes the only thing that matters, and the only thing that is actually holding them together.

In  those cases, will power does not refer to an individual’s desire to stop drinking.Willpower is more likely to be seen in how an alcoholic will try their life board in order to allow them to keep drinking, and somehow seemingly hold themselves or their lives together, however precariously.

This sense of trying to force life to happen, regardless of the reality of how that life presents itself, is often a key characteristic of alcoholism. It is often referred to as self will, which is one expression of this type of enormous energy that somehow can manifest itself in a drive to create and living what in today’s jargon is referred to as a virtual reality.

 

REHAB ADDICT TREATMENT

Anyone entering a rehab is likely to be referred to as an addict.

This is in one sense a bit of a label, in another sense anyone entering a rehab is looking for help or treatment with one or more  addictions, either to alcohol, drugs, gambling, food or a combination thereof.

Inevitably, a rehab  or treatment center will offer a wide range of treatment addiction programs, normally based upon the 12th program of Alcoholics Anonymous, as a way of helping the individual overcome any or all of these addictions.

This approach may work for some people, may be helpful to some people and  unhelpful for other people.

When treatment centers first came into being they were essentially hospitals and detox units for people who had a problem with alcohol, such people commonly referred to as alcoholics.

Truman centers then began to work with and help people who had other addictions such as narcotics and prescription drugs, and would refer to these people as being dual addicted.

Over time people were admitted to rehabs and treatment centers who were not only  alcoholics, but had other problems as well.

REHAB ADDICT TREATMENT

Treatment centers quickly realised that they could effectively treat anyone who had any addiction to anything, if they focused their efforts on the person, and treated their addictive substance or behaviour as ‘a drug of choice’.

Whether this approach was based on clinical evidence or not is unclear, but it did allow a  significant growth in the number and scope of treatment centers and rehabs.

The potential problem with this approach, and the categorisation of everyone as an addict,  is that it can be a slight distortion of an individual’s reality.

Dealing with the underlying emotional causes that can fuel someone’s alcoholism or addiction to drugs or other substances is inevitably going to be helpful, but it can also distort reality of what an individual’s problems with that substance or behaviour actually are.

There is a danger of fine tuning reality to fit a model that suits the finances and growth of the treatment center industry.

That is not to say that the majority of rehab’s and treatment centres do not approach that addiction treatment programs correctly, the majority of them do.

What is important is that any addiction treatment program at a rehab treatment center offers is based on solid clinical evidence and on solid therapeutic evidence such as the process of the 12 step program of Alcoholics Anonymous.

ALCOHOL ABUSE TREATMENT

Alcohol abuse is a term that is often used amongst many others, such as alcohol dependency, when people are in some senses either trying to avoid using the word alcoholism,  or when people are quite significantly opposed to the idea of alcoholism being a progressive illness.

In some ways, the terminology itself does not really matter.

People debate the nature of alcoholism, whether or not it is an illness, and whether or not a rehab or treatment center is the best option, whether people should or should not use Alcoholics Anonymous etc.

Whilst all of these are valid questions and debates in their own right, the reality is that someone has a drink problem it should be owned as such, either by the individual themselves if they are able, or by family members, or by an employer or friends.

If the fact that the person has a drink problem can be owned, that Lisa is a process set in motion whereby the nature of the problem is identified, whatever the terminology.

Once a problem has been to some extent owned, then at least a search some type of solution will move forward.

If the debate stays around terminology, be it alcoholism, alcohol abuse, binge drinking, Alcoholics Anonymous, then quite literally the person may never get the proper help and treatment that they need.

ALCOHOL ABUSE

There is a much greater sense that if people are open to the reality of their lives, then they can see over time clearly the nature of the problem and of the solution.

Alcohol abuse may relate to either active alcoholism, heavy drinking at a sustained level, periods of binge drinking or simply a long-term decline in an individual’s sense of motivation and purpose about the life.

Getting an individual to relate to the fact and understand the fact that they have a problem with alcohol is obviously the most difficult and pressing challenge.

If someone is an alcoholic or has a serious alcohol addiction and / or alcohol abuse there is a fair chance that at some point they have moved that locus of control from within themselves to alcohol.

At this point they are likely to see alcohol as being the solution to their problems, rather than the problem itself.

It is this viewpoint that is the most damaging to both themselves and their own lives, and is without doubt the most difficult barrier to get the  the person to lower and seek help.

Signs of Alcoholism Treatment

When people talk about signs of alcoholism, there is quite often a sense of a hidden agenda, which is sometimes unfair but which often pervades a fear that other people may have about someone else’s drinking or their behaviour associated with drinking.

Whilst many people still debate the nature of alcoholism, there is a widespread belief that an element of it is at least hereditary, witnessed by the fact that a significant number, if not a majority of members of Alcoholics Anonymous who are sober grew up in alcoholic homes.

Whilst none of this is literally provable, whilst Alcoholics Anonymous continues to grow, there are essentially second and third generation recovering alcoholics, a lot of whom give witness to this fact that there is a sense of generational alcoholism within their families.

It is partly this reason that leads people to be overly conscious and perhaps a bit sensitive to their own children’s drinking and behaviour, at different ages and different stages.

If someone has either recovered from a drink problem themselves, or is aware of alcoholism within their family, then there is a real sense that they are likely to look out for signs of alcoholism within their own family, and especially within their children.

There is often a line of thought that if you can spot the signs of alcoholism  early enough, then some type of treatment can be administered early enough and in the case of an adolescent or young person’s drinking perhaps prevent many years of active alcoholism.

Whilst this line of thinking is very understandable and in some sense reasonable, there are dangers to it.

SIGNS OF ALCOHOLISM TREATMENT

One particular danger is that of essentially shipping and adolescent or young person off to rehab, often against their will, because someone else believes they might have a drink problem.

Sadly many rehabs encourage this type of intervention, and will use the parents fear as a way of engineering a perceived need for some type of alcoholism treatment.

Any type of intervention of this nature, at any age, can quite literally do more harm than good.

In many ways,  if a parent is in recovery from alcoholism themselves, or there is this issue of generational altruism, then the family would be much better encouraged to attend meetings of Al-Anon and Al-Ateen, where the individuals will be exposed to the reality of our close as it has affected them.

In addition they are likely to attend open meetings of Alcoholics Anonymous, and overall come much more educated about the nature of alcoholism, both within their family and potentially within themselves.

This is probably the best type of preventative treatment – education.

Different types of Alcohol Rehab

‘If you or a loved one has a problem with alcohol addiction, the first step is admitting the need for help and evaluating the different types of rehab options.

It may seem like a small step, but it is essential to learn more about alcohol rehabilitation options.

One of the biggest questions is what kind of treatment is the best choice.

Some people find success with outpatient treatment such as therapy and support groups.

However, others require inpatient treatment if they are showing signs of severe physical withdrawal because some of the symptoms can be dangerous and require medical care.

Inpatient treatment

The purpose of inpatient treatment is to remove the person from the triggers and stressors that may lead to continued alcohol abuse and place them in a controlled setting where they can no longer use alcohol.

According to research, the other objective is to provide comprehensive treatment and to evaluate their needs for a complete and successful rehabilitation.

Those who have medical issues that result from alcohol abuse and sudden withdrawal will be examined by medical staff and in some cases will receive medication to help alleviate the symptoms.’

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SOBER LIVING

When people talk about sober living, they are invariably talking about people who have been alcoholics or sometimes drug addicts or possibly both who have got clean and sober, and are trying to rebuild their lives both internally and externally.

Living sober is a title of one of the books published by Alcoholics Anonymous that gives a wide range of practical advice to people who are newly sober, about how to handle a wide variety of practical and emotional situations that they may encounter.

Sober living tends to refer to a much longer process, and sees day-to-day living as being that process in action.

Sober living can also refer to a development that has come about in recent years, which is commonly referred to as sober living in houses.

The scope of what sober living houses mean can vary quite widely, and sometimes can be linked to specific treatment centres or rehabs.

The intent behind sober living housing is for people who are in early recovery from alcoholism and possibly drug abuse as well can live together in a safe and clean environment, and have mutual support from each other, as well as possible input from some type of key worker or therapist.

Sober living housing can sound a great idea, and can often work really well in practice.

SOBER LIVING

Where sober living housing can run into problems is quite simply the nature of the environment.

Putting together a number of people who are in early recovery from alcoholism and drug abuse is both potentially hugely important in terms of providing a safe environment, but is also potentially something of a time bomb emotionally if not managed in an appropriate manner.

It is probably fair to say that anyone in the early recovery from alcoholism is struggling to deal with a wide variety of conflicting emotions, the most common one doing an oval office level of anger.

It often does not take much for these emotions to spill over, and in the context of alcoholics and addicts in recovery living together this can be a tense situation or environment.

Luckily most sober living housing will realise this potential conflict, and will put in place a number of practical measures to minimise such confrontations.

Sober living generally, aside from sober living housing, is a hugely important aspect of recovery, and is a hugely broad subject come sing a wide range of approaches and techniques that people use in order to be able to live a life with a degree of stability in a world that used to frighten and overwhelm them.

ALCOHOLISM and ADDICTION

Alcoholism and addiction often lumped together as being the same thing, with alcoholism simply being an addiction to alcohol.

Anyone trying to understand the nature of alcoholism for several reason, will quickly understand that whilst an addiction to alcohol is certainly part of the nature of alcoholism, the term itself encompasses an illness that is much more than simply a physical addiction craving for alcohol.

There is much medical debate, still, about alcohol, alcoholism, alcohol dependency etc. What is much more pronounced in terms of recovery is that  there is a lots of help available, either through cost at programs such as Alcoholics Anonymous, through residential treatment centers and rehabs and a number of outreach alcohol and drug recovery teams in local communities.

The idea of alcoholism being an illness was first put forward in the book Alcoholics Anonymous, and has become widely accepted in the recovery movement as being true.

What is less widely accepted is what the nature of that illness is.

As with a lot of illnesses, if you want to have a real picture of what alcoholism is, then the best place to go is to an individual who suffers from it.

In this context talking to someone who is an alcoholic in recovery is likely to give an insight into some of the traits and behaviours and thought processes that lie beneath a very obvious drink problem of which the alcoholic is very often in active denial of.

ALCOHOLISM and ADDICTION

Going to a meeting of Alcoholics Anonymous would allow someone to hear a wide variety of different experiences of alcoholism, all of which would have points that were very different from each other, and all of which would have points that were in some ways markedly similar.

The thing that perhaps is most important to realise is that for the majority of alcoholics, at some point in their drinking they see alcohol has been the solution to their problems, rather than the problem itself.

The majority of alcoholics will deepen  this belief and lead a life that effectively protects alcohol as they increasingly believe it is the only thing that is holding them together both spiritually, mentally and physically.

 

ALCOHOLISM OUTPATIENT RECOVERY

The nature of alcoholism can sometimes be debated in a theoretical sense, the most common debate being between nature and nurture.

There is a place for this debate, but for the majority of people are causing is best understood either by those who have it, those who are in recovery from it and those who are otherwise widely affected by it i.e. family, friends, employers and society generally.

The belief that alcoholism is an illness is relatively recent in medical terms, and is generally accepted although there is some dissent in certain countries.

Whilst this is important, what is more important is to get people who have a drink problem that is destroying their lives and the lives of those around them any type of help that will work, will help to get them sober and more importantly keep them sober.

Most people assume that if someone has a drink problem the starting place for their recovery is a treatment center or a rehab, where they will go for a residential stay normally of up to 28 days, and then when they come out 10 meetings of Alcoholics Anonymous, and stay sober that way.

This is certainly one route, and certainly a common one for many people.

ALCOHOLISM OUTPATIENT RECOVERY

What is also true is that there are many many more millions of people who go directly to meetings of Alcoholics Anonymous and never go near a rehab treatment center, either residential or outpatient.

This is not to knock treatment centers or rehabs, simply to make the case that there are many ways people can use help that is available in order to get sober.

People can certainly go to a rehab or a treatment center, people can do to meetings of Alcoholics Anonymous or other 12 step fellowships or a variety of what are commonly referred to as secular organisations which tends to use it on end as life skills to help people get sober as a posed to a 12 step program.

There are many residential treatment centres and rehabs which also offer outpatient help, either as an extension to a resident’s addiction treatment program once they have left that we have, or simply as a form of outreach work to the local community.

There are many people who use different types of recovery who are able to carry on working at the same time, who simply would not be able to either take the time or do not have the money to go into a residential rehab.

ALCOHOL POISONING

Alcohol poisoning is not often talked about in the context of rehab or treatment for alcoholism and drug abuse, but is a hugely important part of the recovery process.

The issue behind alcohol poisoning is twofold.

Firstly is the reality of where someone who has been drinking alcohol for a long time has got to, in terms of the damage they have already done to their body and mind, and the need to recover from it.

Secondly is the potential damage that alcohol can do to an individual, whether they are a heavy drinker or an alcoholic.

The key to helping people understand about alcohol poisoning is education.

This is not to say that simply educating people  will free them from alcoholism or heavy drinking, but it will help to create an environment where people can understand much more readily the issues behind why people drink, and what help there is available for them and their loved ones.

ALCOHOL POISONING

Anyone who has had dealings with an alcoholic or heavy drinker will be well aware of how difficult it can be and usually is to get them to see that they have a problem.

In the understanding of alcoholism, it is generally understood by people who are themselves recovering alcoholics and people who work in the field of alcoholism, that the extent of denial that most  alcoholics have of the problem is essentially a defence mechanism.

It may be a bit odd to call it a defence mechanism, but for most alcoholics call at some point becomes the solution to their problems, rather than the problem itself.

This may be in stark contrast to the reality of the life of an alcoholic, which may well be in total chaos, both internally and externally.

It requires a level of experience of alcoholism to fully understand this, but it is also widely accepted that the mind of the alcoholic is often as abnormal in this record as is the body of an alcoholic in terms of how they react to alcohol.

Alcohol poisoning can be a real and substantive threat to individual who drinks too much, be they an alcoholic or not.

It is hugely important that people educate themselves and others, both formally and informally as to the dangers of alcohol and alcoholism, and hopefully this will begin the process of making a significant contribution to the problem.

Alcoholism Detox

An alcoholism detox is  possibly going to be needed in the event of anyone who is an active alcoholic, or even someone who has been drinking heavily for a long period of time but would  not technically be considered an alcoholic.

Sometimes there is much debate between what is alcoholism and heavy drinking, but in the  issue of recovery from alcoholism, and in particular the need for an alcoholism detox, it is a fairly irrelevant issue.

Anyone who has a serious problem with alcohol is likely to need help, whether they admit that themselves on what.

It is sometimes much more obvious to people around them, be they family, employer, co-workers or simply friends.

Whether or not help is offered and / or accepted can obviously be a difficult issue.

Assuming that the person who has a drink problem is willing to accept some sort of help, then the issue of an alcoholism detox is likely to occur.

ALCOHOLISM DETOX

Anyone who has been thinking heavily is likely to have been hiding that in some way from people close to them.

People who have a drink problem increasingly grow protective of alcohol, and the need to prevent other people taking alcohol with from them, or stopping them trying to drink.

In addition, it is quite possible that people who have a drink problem, or who are alcoholics, have either in the past of currently been using some type of narcotics or drugs.

The issue with all of this, is that it is quite unlikely that either the alcoholic admits to a lot of this,  or that people around them will know the full extent of their drinking and possible drug use.

For this reason it is really important that anyone seeking help for a drink and/or a drug problem is assessed by medically qualified personnel to see if they need a medical detox, and if they do for that detox to be overseen and undertaken by medically qualified staff in a safe clinical environment.

If the individual with a drink problem is entering a rehab, then it is important to check that the rehab has access to such staff and facilities, either in-house, or with a local clinical facility such as a hospital.