Alcohol Rehab or Alcohol Detox?

It's suggested that if you have a drinking problem you must attend a medically licensed alcohol rehab facility. But if we look at those alcohol related conditions which can and cannot be medically treated, the value of an alcohol rehab becomes highly questionable.

Alcohol Rehab or Alcohol Detox?There are many health issues brought on by heavy drinking for which the medical world can provide proper treatment or rehabilitation. The list is long, here are just a few:

  • alcoholic hepatitis
  • cirrhosis
  • pancreatitis
  • hypertension
  • gastrointestinal conditions
  • delirium tremens
  • alcohol withdrawal syndrome

All of these conditions can be medically treated in one way or another. The question is, are these conditions treated in alcohol rehab, and is this the proper setting for treating such conditions? Clearly, addiction counselors, psychiatrists, and therapists are not equipped to treat such problems. And ultimately, most alcohol rehabs would send a patient off-site to an outside doctor to receive diagnosis and treatment for most of these problems.

There is one very immediate condition related to heavy drinking that the medical world has done a fantastic job of addressing, that is - physical alcohol withdrawal. Severe Alcohol Withdrawal Syndrome can lead to deadly seizures, and this is a state in which medical attention is necessary. The normal alcohol detox process involves checking into a hospital detoxification unit for a period of 3-10 days where a medical staff monitors your vital signs around the clock and administers drugs to control withdrawal symptoms as your body acclimates itself to the absence of alcohol. If any seizures should occur, they can quickly be addressed in such a setting.

NOTE: We highly suggest that if you feel you may be experiencing any alcohol withdrawal symptoms, that you immediately contact your doctor or the nearest emergency room and seek appropriate medical advice or help with detoxification.

The truth is though, that most people need medical detoxification for their alcohol problems. Certainly, the 75% of people who end their alcohol problems without any sort of treatment get by without it [1]. Furthermore, one landmark treatise on alcohol use concluded that:

Sometimes outpatient nursing aid and a moderate sedative are called for, but in fewer than 15 percent of all cases of withdrawal distress is medical intervention required [2]

So remember, that's not 15% of all alcoholics in total - it's a smaller number of only 15% of those alcoholics who feel withdrawal distress who then fit into the category of needing medical intervention. So only a tiny portion of alcohol users actually need medical detoxification while in an alcohol rehab. Yet this is almost the only service that alcohol rehabs offer which they can honestly call medical treatment.

Even the highest authorities in the land are completely mixed up on whether detoxification is relevant to what they call addiction. When it fits their purposes they'll often list withdrawal symptoms as evidence of the disease and the need for an alcohol rehab, and other times they'll dismiss it as unimportant. For an example of this contradiction, I look to a 1999 interview with Alan Leshner [3], head of the NIDA at the time. Early on in the interview, Bill Moyers (who I might add is fully supportive of Leshner's view of addiction) asks about the scientific grounding for the idea that addiction is "compulsive, uncontrollable" substance use. Leshner answers:

I'm very frequently asked, "Is this drug addicting? Is this drug more addicting than that other drug?" and what people want to hear is whether or not it causes physical addiction. That means when you stop using it you go through these dramatic withdrawal symptoms we've all seen in the movies and on television like shivering, gastrointestinal problems, and cold sweats, but the truth is that doesn't really matter in addiction.

So on the one hand, physical withdrawal doesn't matter, and there is some validity to this statement. If physical addiction were the defining and important factor in addictions, then people would only display addiction to opiates, benzos, and alcohol - yet people display identical behavior in addictions to speed, cocaine, methamphetamine, marijuana, ecstasy, and inhalants among other things - drugs which cause no comparable physical withdrawal effects. The experts know this, which is why they've downplayed the importance of physical withdrawal symptoms, yet a few questions later, Leshner says this:

People who are addicted initially take the drug because it makes them feel good, but over time they just take it to return to normalcy. Heroin addiction is a wonderful example. Initially, people take heroin because they like the high, but over time they keep taking it to avoid withdrawal sickness.

This is clearly contradictory to Leshner's original response! The truth is that for some people at some times, physical withdrawal symptoms can influence choices about substance use, but the phenomenon in and of itself isn't "addiction", nor is it important to long term cessation, if it were, then we could treat people in 7 days by detoxifying them, and there would be no way to justify the existence or purported necessity of 28 day alcohol rehabs and the like. Well, there still may be no way to justify their existence, even if they include detoxification.

Alcohol Rehab Costs Don't Add Up

In my own analysis of the 32 rehabs reviewed on the slick recovery website[4], I found that most of them (26) offered detox services on-site. The average daily cost of these gold standard alcohol rehabs (most of whom probably employ the Minnesota Model of treatment) is $898.00 per day. Next, I called a hospital detox unit to ask the daily price for alcohol detox, and found that it's $750.00 a day for a self-paying client.

What's significant about these numbers? Well, the detox part of a 28 day alcohol rehab is just about the only real medical treatment they provide. When you go to one of these programs you'll pay a price that's $148.00 higher than the cost of detox in an actual hospital - that's $898.00 for every one of the 28 days you're there - yet detoxification really only takes 3-10 days. How do they justify charging you so much money for the other 18-25 days? I really don't know. I personally attended one such facility and I was taken off site for any other medical issues. And the cost of any medicines prescribed while you're in rehab certainly isn't included. What's more, the bulk of services that you're receiving are simply indoctrination into twelve step dogma - something you can get for free at any one of thousands of twelve step meetings available all over the world at any given hour of any given day.

My conclusion here, is that the only reason to go to a 28 day alcohol rehab is if you want to learn the twelve steps and have a new environment to live in while you do it. My reasons are - you can get detox services (if you even need them) elsewhere for a significantly cheaper price (and medical insurance or state aid programs will likely cover that cost anyhow). And if you have health problems caused by your alcohol intake, these alcohol rehabs essentially won't treat you for those anyways - they'll send you offsite to a doctor's office or hospital - so why not just see your own doctor and the specialists he recommends for these problems? Starting such treatments for hepatitis or other complex conditions in another state with another doctor who you won't see again after you leave rehab just adds another level of difficulty to the whole process, as you then have to continue the treatments with someone else when you return home.

Ultimately, alcohol rehab seems like a bad deal. If you want to address real health problems, consult a doctor - not a rehab. If you want to address the choice to use alcohol, consult the experts on choice: Freedom Model Retreats.

[1] Recovery from DSM-IV alcohol dependence: United States, 2001 - 2002 Deborah A. Dawson, Bridget F. Grant, Frederick S. Stinson, Patricia S. Chou, Boji Huang & W. June Ruan Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA

[2] Fingarette, H. 1989. University of California Press. [Kindle Version]. Chapter 4: Have "Alcohol Treatments" Really Worked?, Incoherent Doctrine and Practice.

[3] Moyers On Addiction, PBS, WNET New York "Close To Home", Transcript of an interview Alan I Leshner Ph.D. Retrieved June 15, 2011 from:

[4] TheFix.Com Rehab Reviews, retrieved June 9th 2011 from:


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