Susan Hochstedler, RN, CADAC, is a nurse at Addison Gilbert Hospital in Gloucestor, MA. She works full-time with substance abusers in The Discovery Program, an addictions day treatment program.

"Most of our clients are either alcoholics or heroin addicts, and we start with a 3 to 5 day detox, followed by rehab. The rehab program is essentially a huge overhaul of the addict's life. A big part of rehab is teaching clients how to use AA, because we find that the single most important factor in maintaining sobriety is going to AA and liking it. But beyond this, the addict's entire lifestyle needs to be reordered, because situations that used to be part of everyday life are now high risk and potential triggers of relapse. For example, we teach clients how to manage the holiday party. Many alcoholics think it's fine to drink O’Doul’s and other nonalcoholic beers, but in fact it's a bad idea, because it elicits so many emotional cues. The brain is saying, ‘Hey lady, you're shooting blanks, let's get the real thing.’ From my experience working with these patients, there are three things that I tell MDs: 1. Don't go it alone, always work with a counselor in treating these patients; 2. When psych meds are not working for a syndrome, think substance abuse before changing the psychiatric diagnosis; and 3. Don't be afraid to use meds like Antabuse and naltrexone early after detox, because these patients need all the help they can get."