How can a functioning alcoholic who doesn’t have time to check himself into rehab get help?

4 Steps Toward an Addiction-Free Life Without Attending Rehab

Thinking about cutting back on alcohol or any other drug is the first step toward sobriety. You don’t necessarily have to go to a rehab center for giving up an addiction.

1. Do a self-assessment (most-important step)
   Ask yourself how much you drink each day, every week and why you drink. What impact does the particular drug have in your life (both positive and negative)?
2. Ask for assistance from a loved one
   Involving a person who understands you and is willing to help you in your struggle against this addiction is vital to becoming sober. Tell your story to that loved one, add every detail. Tell him/her how alcohol has ruined your life and you don’t want to continue with this anymore. Get back to that loved one when you experience cravings.
3. Change your company
   Give up on meetups with friends who are alcoholics themselves. Thinking you will be able to say NO to them is foolishness and you should never test your patience if you really want to give up on addiction.
4. Drink until you are full
   During counseling, I tell people that if they start to experience strong alcohol cravings then they should start to drink any other drink until they are full and can’t even drink one more drop. For this, all alternate drinks that you like must be readily available to you. These drinks may include hot chocolate, juice, pineapple juice, some soft drink, or any other drink of your choice.

Match the Treatment to the Severity of the Illness

Treating alcoholism outside of an inpatient setting requires professional support and intentionality and information. The client/patient must be evaluated to determine if a medical detox is necessary. If the client is alcohol-dependent, they will need to be medically supervised during the detoxification stage because withdrawal from alcohol is not only very uncomfortable but it can be fatal.

The chronic overuse/misuse/problematic use of alcohol is an illness; it speaks to the person having a brain that reacts to alcohol with a response that registers the impact of alcohol as the desired effect, an exaggerated impact, being encoded by neurotransmitters (particularly dopamine) as “Wow, that was better than expected.” It might help to think of it as a “hyper response.” Not everybody has that reaction, although alcohol’s disinhibitory impact is felt by everyone and the social lubrication is experienced by most.

Those prone to chronic overdrinking and who meet the criteria for the diagnosis of alcoholic can get there in several ways:

1. Trauma, often childhood (but not limited to) – The experience of trauma (acute or chronic) changes the brain in a way that makes the brain more likely to respond to alcohol (and other substances) with a hyper response.
2. Triggered by a substance – Early use of alcohol on a brain can work together with trauma or heritable factors to “flip the switch” toward the development of a problem. Younger brains are more vulnerable to greater impacts.
3. Genetic vulnerability – Research shows that there is a genetic propensity towards over-drinking.
4. Reward insufficiency – Research suggests some people who chronically overdrink do so because they do not experience reward and pleasure in a neurotypical manner.
5. Learned behavior – Some people may drink themselves into the behavior, actually hard-wiring the habit into their brain over years of the habit, often using drinking as their only “coping skill.”
6. Co-occurring mental health issues – It’s common for people with untreated mental health issues such as anxiety and depression to use alcohol (or other drugs) to quell the symptoms of the untreated mental illness.

It is perfectly possible, and common, to be quite a high functioning and have a severe alcohol problem. Many persons with a developed alcohol use disorder have professional jobs, partners, good credit scores, roles in their communities, advanced degrees, and live otherwise full and functioning lives. It’s not uncommon for them to seek alternatives to typical 28-day treatment or mutual help groups.

Building a DIY treatment is possible, but it takes commitment and intentionality, and care. Here are some tips:

• Seek a medical evaluation to determine if a medically supervised detox is necessary.
• Seek the help of a specialized, licensed mental health professional. Alcohol use disorder and the issues of being in a high functioning role have characteristics that require that your professional have specialized experience and techniques. This is not a situation where a generalist can adequately help.
• Be sure to collaborate with your provider for a custom treatment plan that matches your history, health level, personality, and goals.
• Be open, and honest that one of the symptoms of the illness is to protect the use of alcohol; this can show up as a “negative first reaction” to suggestions for change. While custom treatment planning is needed, a resistance to all, many, or most suggestions might be a function of the illness.
• Incorporate habits of thinking that are neuro-beneficial. This means habits that have a significant pay-off in terms of the brain. Here are some that help with not only recovery from substance abuse, but also co-occurring issues such as trauma, anxiety, depression. They also assist with stress management, relapse prevention, and insomnia.

1. Exercise
2. Contemplative movement (such as yoga or tai chi)
3. Meditation
4. Journaling
5. An intentional gratitude practice
6. Regularly volunteering
7. Social connectedness (fellowship, or worship falls into this category)
8. Meaningful work or purpose
9. Personal transformation (as accessed through therapy, a retreat, the 12 Steps)
10. Outdoor and adventure challenges
11. Laughter (I kid you not, see what I did there?)
12. Structure, routine, ritual
13. Spirituality practices (that match individual preferences) – these can include disciplines such as prayer, forgiveness, solitude,
14. Creativity (music, art, or be creative about the activity)
15. Mutual help groups – 12 Step, Smart Recovery, Refuge Recovery, Celebrate Recovery
16. Medication-Assisted Treatment (be sure to find a qualified specialist)

The key is to curate “enough” of the treatment to match the aggressiveness of the illness. Just like other illnesses, you must put together enough treatment to match how severe the illness is. Also know that for many of the items on the list, you are building a new brain.

The habit of drinking has been codified into neural pathways. You need to atrophy that pathway and create new, healthy ones. This can be a slow process. While exercise has short-term benefits, for example, the long-term changes are cumulative and take some time to build. The same is true for other items on the list.

Finally, it helps to think in terms of working towards something positive vs. away from something negative. So, instead of “not wanting to get a DWI” may be an okay start but “wanting to enjoy living in a sober body” is a more powerful motivator long term.