How De-Addiction Treatment Works
The word people are actually afraid of
When a family says the word “rehab” in my room, I can usually see what they are picturing. Gates. A van. A man being taken somewhere for six months and coming back different, or not coming back at all. Somebody knows somebody whose cousin was beaten in such a place. In some parts of this country that fear is not paranoia — those places exist.
So people wait. They wait years, and the waiting costs a liver, a marriage, a job, sometimes all three.
Here is what I would want my own family to know: for most people, treatment for alcohol or drug dependence is an outpatient business. It is appointments. It is conversation. It is a tablet and a follow-up date. Nobody is taken anywhere against their will, and if somebody tries to, that is not treatment and it is not legal.
The short answer
Treatment has three parts. They start in order and then run alongside each other.
- Getting off it safely — days. Sometimes needs admission, usually does not.
- Staying off it — months to a year or more. This is the actual treatment, and it is mostly outpatient.
- Treating what is underneath — depression, anxiety, sleep, sometimes a physical illness nobody had looked at.
The first part is the one everybody imagines. The second part is the one that decides how this goes.
The first appointment
Less dramatic than expected. Longer than expected.
I ask what he drinks, how much, since when, at what time of day, and what happens on a day he cannot get it. I ask about the previous attempts, because there are almost always previous attempts and they tell me more than the current one does. I ask about fits, about jaundice, about vomiting blood, about diabetes and blood pressure and the tablets already in the house.
Then I examine him. Then, usually, blood tests — liver, sugar, blood counts, sometimes more.
And I ask about the rest of it. Sleep. Mood. Whether he was already low before the drinking got heavy, or only after. Whether there were months of not drinking where he still could not get out of bed. That question changes the treatment plan more often than any test result does.
Family are welcome in the room, with his permission, and I usually want them there for part of it. But the consultation belongs to him. Adults are treated with their consent — that is not a courtesy, it is the law.
Part one: getting off it safely
Covered properly on its own page, because it is the part with the real risk in it. Short version: a person who has been drinking daily for years cannot simply stop on a Monday morning without medical cover. Withdrawal is treated with a short, tapering course of medicine, vitamins and fluids, over roughly five to seven days, and most of it can be done from home with close follow-up.
Then it is over. And this is where most families think treatment has finished.
It has not started.
Part two: staying off it
This is where the outcome is decided, and it is the part nobody plans for.
There are medicines whose whole job is to reduce craving, or to make drinking less rewarding, or to make it physically unpleasant. They are taken for months, reviewed regularly, and they are not sedatives and not habit-forming. They are also not magic — they work by making the effort possible, not by removing the need for effort. Which one, if any, suits a particular person depends on their liver, their other illnesses, and frankly on whether they will actually take it.
I am not going to name them here, and I would be suspicious of any website that does. That is a conversation with a doctor who has your reports in front of him.
Alongside the medicine: appointments. Weekly at first, then fortnightly, then monthly, then longer. Somebody looking at this with you on a regular basis, over a long period, is not an administrative detail — it is one of the more reliable parts of the treatment.
Part three: the psychological work
People hear “counselling” and picture being lectured. Nobody in this field has time for that, and it does not work.
The actual work is narrower and more practical. What are the situations in which he drinks — the specific ones, the Friday, the wedding, the drive home past a particular shop. What does he do instead, and has he rehearsed it, or is he planning to improvise on the night? What does he tell people who offer, and what does he tell them the second time they insist? How does he handle the first hour of a craving, which is the hour that matters?
And underneath all of it: what does not drinking cost him socially, and what is he getting in exchange? If nobody answers that honestly, the plan is decoration.
Some people also benefit from a group — Alcoholics Anonymous and similar meetings exist in most Maharashtrian cities. It suits some people extremely well and others not at all. It is worth trying twice before deciding.
What families are for, and what they are not for
Families arrive wanting a job. Usually the job they want is policing — checking the breath, searching the cupboard, counting money.
I would ask you not to take that job. It fails, it is exhausting, and it converts every conversation in the house into an interrogation. Worse, it makes his recovery your responsibility, which means every relapse becomes your failure.
What genuinely helps is duller. Being at the appointments. Knowing what the plan is. Not keeping alcohol at home during the first months. Not treating a slip as the end of everything. And — this is the one people resist — getting some support for yourself, because living with this for years does real damage that nobody ever asks about.
How long does all this take
The honest answer: the risky part is days, the intensive part is a few months, and follow-up continues for a year or more, spacing out as things stabilise.
People hear “a year” and flinch. But by month four this is usually one appointment a month and a tablet. That is a smaller intrusion into a life than the drinking was.
Relapse
A significant number of people drink again at some point during treatment. Being told that in advance is not permission — it is preparation.
A person who has been told relapse can happen comes back the next week and says so. A person who has been told relapse means failure disappears for eight months and returns worse. I have seen the second version far more often than I would like, and the difference was usually one sentence somebody did or did not say at the start.
A slip is information. It tells us what the plan did not cover.
If a residential facility is genuinely needed
Sometimes it is — repeated failed attempts, no safe home environment, serious co-existing illness, or a withdrawal that needs watching around the clock.
If it comes to that, look at government options first. District hospitals and government medical colleges have psychiatry departments, and there are de-addiction centres funded by the Ministry of Social Justice and Empowerment operating across Maharashtra.
And whatever you are considering, ask these questions before anyone signs anything:
- Is this establishment registered with the State Mental Health Authority under the Mental Healthcare Act, 2017? Ask to see it. Registration is a legal requirement, not a formality.
- Which qualified doctor sees the patient, and how often? Get a name and a registration number.
- Can the family visit, and how often? A place that restricts visiting entirely is telling you something.
- What is the discharge plan, and what happens on the day he comes home?
Physical restraint, beating, forced admission and cutting a person off from the outside world are not treatment methods. They are offences. The Act protects the person being admitted, not the family admitting him, and that distinction is the whole point of it.
A story, put together from many
The following is fictional and composite. It is not any one patient.
A man in his fifties came in because his daughter refused to get married while he was drinking. He was furious about being there. He sat through the first consultation answering in single words.
The withdrawal was managed at home over a week. Uneventful. He came back at three weeks looking well and told me he was finished with all this and did not need to come again.
He drank at a wedding in the second month. He came back and told me — that was the part that mattered. We had spent one appointment on exactly that scenario and he remembered enough of it to be embarrassed rather than to vanish.
He is still coming, less often now. What changed was not willpower. It was that he stopped treating each appointment as an admission of weakness. That took about five months, and it was the treatment.
What to do this week
Book a consultation with a psychiatrist or a de-addiction specialist. Do not wait for him to hit a bottom. The bottom is a myth that has cost people years.
- Write down: what, how much, since when, previous attempts, any fits, other illnesses, all current medicines.
- If he will not come, go yourself first. A consultation about how to approach him is a legitimate use of an appointment and is often where this starts.
- Do not stop him abruptly at home while you wait for the appointment.
- If a residential facility is suggested to you, ask for the registration before you ask about the fees.
Frequently Asked Questions.
Will he have to be admitted?
Usually not. Most treatment for alcohol dependence in India is outpatient. Admission is a clinical decision based on risk, not the default.
Can he be treated without knowing? Can medicine be mixed into food?
No. Giving medicine to an adult without their knowledge is unsafe and unlawful, and I will not do it. Families ask this often and out of desperation rather than malice, so it is worth answering plainly rather than with a lecture.
Do the anti-craving medicines become another addiction?
No. They are not sedatives and they do not produce a high or a craving of their own. They are stopped on a plan when they are no longer needed.
Does treatment work if he is only coming because we forced him?
Often, yes. Reluctant arrival is the norm rather than the exception. Motivation is not a prerequisite for the first appointment — it is frequently a product of the first few.
Sources
- Indian Psychiatric Society. Clinical Practice Guidelines for the Assessment and Management of Substance Use Disorders.
- The Mental Healthcare Act, 2017 (Act No. 10 of 2017), Government of India — registration of mental health establishments, and the rights of the person admitted.
- Ambekar A, et al. Magnitude of Substance Use in India, 2019. NDDTC, AIIMS New Delhi, for the Ministry of Social Justice and Empowerment.
- Ministry of Social Justice and Empowerment, Government of India — National Action Plan for Drug Demand Reduction.
This article is for education only. It is not a substitute for consultation with a qualified doctor, and it is not a diagnosis or a treatment plan for any individual reader.
If you or someone you know is in distress, free and confidential help is available. Tele-MANAS: 14416 or 1800-891-4416, 24 hours, in Marathi and other Indian languages.
About the author: Dr. Muktesh Daund is a Consultant Psychiatrist and De-addiction Specialist (MBBS, DNB Psychiatry) practising in Nashik, Maharashtra since 2016.