The purpose of alcohol rehabilitation is to facilitate change in the individual from compulsive, chaotic drinking to meaningful sobriety. Some argue that this process takes 2 years and the time can vary considerably from person to person. Holistic alcohol rehabilitation usually involves a bio-psycho-social approach.

Biological: alcohol detoxification may be a necessary stage at the start of the recovery journey. Detoxification involves the prescription of medications which will prevent dangerous withdrawal symptoms such as seizures or Delirium Tremens (DT's). Assessment and treatment of co-morbid or dual diagnosis issues may also be important. Individuals suffering from alcoholism may present with a whole host of psychiatric problems; anxiety, depression, psychosis, OCD, relationship problems, adjustment disorders and anger. Holistic alcohol rehabilitation should address these issues if present.

A number of medications are recommended for the treatment of alcohol dependence. Disulfiram (Antabuse) is an aversive treatment used for many decades in the treatment of alcohol dependence. When used effectively with the support of a relative it can be very helpful. Anticraving agents Naltrexone and Acamprosate are also commonly used in specialist services. Antidepressant and anti anxiety medication may also form part of the biological component of alcohol rehabilitation. 

Psychological: alcohol rehab may also address psychological issues. All rehab for addiction usually involves some form of therapy from the evidenced based therapies of cognitive behavioural therapy, motivational enhancement therapy and twelve step approaches. More recently, mindfulness has demonstrated an evidence base.

Social: alcohol rehab may also focus on the necessary lifestyle changes, family supports and occupational changes to adapt to a sober life. Social skills are often impaired after periods of addiction. Training in social skills can help with these difficulties as can atttendance and active participation in mutual support meetings.

Mutual support meetings for alcohol addiction are widely available throughout Ireland in the form of AA (alcoholics anonymous) meetings. These meetings can provide an enormous support for those in recovery. Secular mutual support meetings (Lifering) are flourishing. Lifering meetings can also provide enormous support in recovery.

Diagnostic criteria for alcohol use disorder

 "alcohol use disorder" or AUD refers to a spectrum of problem drinking ranging from mild through to severe. According to the National Institute on Alcohol Abuse and Alcoholism, AUD is a 'chronic relapsing brain disorder characterised by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences'.

An estimated 15 million people in the United States suffer from AUD. Alcohol Action Ireland state that alcohol consumption in Ireland almost trebled between 1960 and 2001, rising from 4.9 litres of pure alcohol per person (>15 yrs old) to a peak 14.3 litres. 

The Health Research Board's (HRB) National Alcohol Diary Survey revealed 150,000 dependent drinkers and more than1.35 million harmful drinkers.The survey also revealed that 75% of alcohol consumed in Ireland is done so as part of binge drinking and that intake of alcohol is consistently underestimated.

The International classificatory system, Diagnostic and Statistical Manual of Mental Disorders (DSM-5) states any two of the 11 criteria during the same 12-month period constitutes a diagnosis of mild AUD. Moderate alcohol use disorder is diagnosed when there are 4 or 5 symptoms. Severe AUD is diagnosed when there are 6 or more criteria as follows

1. Alcohol is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
4. Craving, or a strong desire or urge to use alcohol.
5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
8. Recurrent alcohol use in situations in which it is physically hazardous.
9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
10. Tolerance, as defined by either of the following: a) A need for markedly increased amounts of alcohol to achieve intoxication or desired effect; b) A markedly diminished effect with continued use of the same amount of alcohol.
11. Withdrawal, as manifested by either of the following: a) The characteristic withdrawal syndrome for alcohol (refer to criteria A and B of the criteria set for alcohol withdrawal); b) Alcohol (or a closely related substance, such as a benzodiazepine is taken to relieve or avoid withdrawal symptoms.

The first step in getting help for problem drinking

When you or a loved one is suffering from problem drinking, the first step prior to engaging with Professor O'Gara's clinic is to obtain a referral from your general practitioner. This allows an assessment of what needs you have and how best to help your particular presentation. Your general practitioner can send the referral either electronically or by post to Professor O'Gara's secretary. For further information contact 01 2771519. When offered an appointment some individuals decide to bring a loved one to the appointment to offer additional information, whereas others like to attend the appointment on their own.

Types of help available

 1. Outpatient Treatment

Although Professor O'Gara works at Saint John of God Hospital and is head of inpatient addiction services at the Hospital, it may also be possible to have outpatient treatment. This entails seeing Professor O'Gara in the outpatient clinic and adhering to a treatment plan based on patient preference. This treatment plan may include seeing other practitioners such as a Clinical Psychologist, addiction counsellor and attendance at mutual support meetings (AA, Lifering) and taking certain medications depending on ones personal preference. Outpatient treatment is likely to be more successful if the individual can maintain good periods of abstinence between episodes of drinking. If abstinence cannot be achieved with a series of outpatient measures including medications as outlined above, then inpatient treatment may be appropriate (see next section).

2. Inpatient Treatment

During the course of an assessment with Professor O'Gara, he can advise on the merits of Inpatient treatment for you or your loved one. The timing of inpatient treatment is very important. Not everyone who presents for treatment is ready for inpatient treatment. The location of inpatient treatment is also very important. Some residential units offer quite different treatments both in terms of the type of treatment and the length of treatment. Professor O'Gara will be able to advise on the best option for you and your family, taking into account your current circumstances. Work and home commitments are often a major hurdle when considering inpatient treatment. The inpatient treatment programme at Saint John of God. Hospital is 4 weeks long. Other treatment programmes outside of Saint John of God Hospital that Professor O'Gara may recommend are considerably longer at 3, 6 and 12 months.

Alcohol problems co-occuring with other addiction problems 

Problem alcohol use occurs very often with other addiction problems. Nicotine addiction is a very common co-occuring problem. Nicotine addiction leads to severe physical difficulties, not least respiratory problems. A whole host of other physical problems such as cardiovascular disease and cancers are associated with smoking. It is very common to address smoking during the course of treating alcohol use disorders. Usually control is achieved on alcohol intake before a reduction and eventual elimination of smoking is broached.

Stimulant use with alcohol is a common presentation. Cocaine and other stimulants (see dedicated section on stimulants on this website). Presentations for problem cocaine use has steadily increased in recent years in Ireland according to 2020 Health Research Board figures. Alcohol plays a key role in the intake of cocaine. Some use cocaine after the intoxicating effects of alcohol. Others take cocaine to slow down the intoxicating effects of alcohol. Alcohol and cocaine combine in the body to form a third pharmacologically active compound called cocaethylene. Cocaethylene itself is addictive and also toxic to organs, particularly the heart. 

Benzodiaepines and other sedative medication (see this section on this website) is also frequently taken with alcohol. It is a common presentation to the inpatient setting for dual detoxification from alcohol and benzodiazepines. Benzodiazepines relieve alcohol withdrawal effects but if used incorrectly are addictive and can lead to addiction if taken over an extended period of time.

Detoxification vs Rehabilitation

The first steps in getting help for problem alcohol intake can be confusing. I am very often asked to explain the difference between detoxification and rehabilitation. Detoxification can take place in the outpatient or inpatient setting. The more severely addicted the individual is the more likely it is that that inpatient detoxification is warranted. Detoxifcation entails using benzodiazepines (usually chlordiazepoxide, otherwise known as 'librium') to safely alleviate the potentially harmful effects of alcohol withdrawal. The most harmful effects of alcohol withdrawal are fits (seizures) and a condition called delirium tremens (commonly known as 'the DT's). Both conditions are readily treated with 'librium' and prevent damage to the body and brain. Without this treatment alcohol detoxification can be dangerous, with lasting damage to the brain and nervous system. Detoxification usually takes around a week, but if the alcohol problem is severe can take up to 2 weeks.

Rehabilitation on the other hand, usually follows detoxification and is the process whereby an individual receives intensive multidisciplinary input. This is in the inpatient setting and lasts between 1 and 12 months depending on the particular programme. Rehabilitation allows time in a protected environment to heal from addictive behaviours. It is warranted when the person has ongoing access to alcohol and cannot maintain abstinence in the community setting. It also allows an intensive input of addiction treatment to occur during the day, every day for a period of time. Rehab programmes in Ireland vary in composition as well as length of time. Some are based on the 12 steps of Alcoholics Anonymous.

 Detoxification and Rehabilitation at Saint John of God Hospital 

I am Head of Addiction Services at Saint John of God Hospital. This programme is a 28 day rehabilitation programme. We also provide full detoxification services. As outlined in above sections, detoxification usually lasts 5-7 days but can be up to 2 weeks in some instances where alcohol dependence is severe. The philosophy of the rehab programme at Saint John of God Hospital is holistic and non-confrontational. Holistic because the programme embraces conventional evidence based approaches like medication and psychological treatments (motivational interviewing, cognitive behavioural therapy and 12 step approaches) but also other approaches that our participants report as useful - yoga, pilates, aikido, mindful body movement, mindfulness, spirituality, physical fitness and family support. For more information on detoxification and rehabilitation help at Saint John of God Hospital contact Professor O'Gara's secretary at Saint John of God Hospital on 01 2771519.