How to Ensure Rehab Doesn't Work
Personal success or failure at rehab hinges on attitude and accountability. A report from Canada.
I went to rehab with a notebook. I was there, I told myself, because I was doing research for a book about a woman who’s an addict and who had to go to rehab because her relapse was affecting her family life—specifically her ability to parent an infant. The program was a three-week deal and it was a two-hour drive from my home in Toronto, Ontario. My husband drove me there, grimly, as if I wasn’t really going for research but rather because I needed help.
Once there I took a lot of notes. The place was full of characters—crack cocaine-addicted sex workers, an alcoholic waitress, a priest, a flight attendant and many men who had signed up to take a little holiday from being in prison or in a gang. We watched educational movies about addiction and partook in bizarre addiction management classes such as Emotional Tapping Therapy.
I went home after the three weeks and I attended an after-care group half-heartedly because my husband nagged me. I stopped going and I drank again. Today, I know that the reason why the rehab didn’t work was because I didn’t take my addiction seriously. The surest way to make rehab work is to believe that it works and then help to maintain that belief via continuous support, such as an aftercare program.
Angie, a parenting expert and therapist in Ontario, Canada, who went to rehab for two weeks in her 20s, was struggling with binge drinking. She also identified her romantic relationships as addictive. She says she couldn’t be alone and it was a problem. Similarly to me, her rehab stint happened because someone else suggested it.
“I didn’t think I needed to go. But I went because the person I was dating thought it would be a good idea and my psychotherapist made it a condition for me to be able to see her,” she says. She drove to the rehab facility in Alberta, Canada, with reluctance. Like me her feelings about being in rehab were all about distancing herself from the reason why she was there. “I thought everyone else is crazy but I’m not. My first impression was, ‘Get me the fuck out.'” She says she went to her sessions grudgingly, hated the food, and thought that the aerobic instructor had no idea what he was doing. She was angry.
I can relate. I was angry too—not just angry, but dismissive. I feel a twinge of jealousy even now when I hear Angie say, “But then something happened. I don’t know if I surrendered but I started to get something out of it. I was able to be funny with people in there; I would laugh, I would talk. I really do believe it helped.” For her, “sitting in those sessions and hearing everybody, the information just sunk in.” And she was able to talk about her difficult past for the first time in her life—she says rehab was the place to do it with the professionals who knew how to handle emotional catharsis like the one she had. She hasn’t struggled with her addiction issues since that time 20 years ago. When Angie got back, her psychotherapist already had a plan for her on how to maintain her sobriety—no alcohol and no dating for a year. “At first, I thought I was going to die. But I did it.” I think back to my aftercare days. I spent more time trying to think up funny nicknames for the people that attended the group than I spent working on my issues.
Liz, a case manager for clients with HIV, has been to rehab 14 times. Her experiences range from going to free inpatient programs in Canada where she lives, to very expensive ones in the United States. Something eventually clicked for her but she says, “A lot of the contacts that I made inside treatment centres taught me more about using. I learned in treatment about scraping pipes, I learned in treatment how to prostitute, how to do all of that stuff.”
Asked about the strangest rehab experience, Liz says, “I went to a fee-based, 80 thousand-dollar a month program that was paid for by a TV show that I was on. You get a flotilla of doctors that are coming in all day long from the community—MD's and psychotherapists—people who draw your aura; it was ridiculous. You have a chef, you have a menu, candle-lit dinners; they make your bed, you’re in the fucking mountains. It was something out of a Woody Allen movie.”
What’s wrong with that?
“You pay for the luxury. To me there was no sense of humility or accountability. Which to me, addicts really need.” She says, “Nothing wrong with self-care, relaxation, pampering yourself, but in my opinion it’s not going to get me well. Not that I need to be scrubbing the floors either but you have to have the sense of accountability.”
And accountability goes beyond showing up for therapy sessions in rehab. Research shows that it is what happens after rehab ends that truly matters.
“Increased aftercare attendance is associated with improved treatment outcomes,” says a 1998 study by Steven J. Lash and Sharon L. Blosser. In the study, the increase of aftercare group therapy and the frequency of it cut the hospital readmission rate by two thirds. It was also noted that, “Guilt and cognitive dissonance discourage individuals from resuming efforts at abstinence and may keep them from returning to aftercare after a relapse or a missed session.” In other words, staying with an aftercare program is effective when you’re already in the right frame of mind—if, like Angie, you have a breakthrough while inside.
Rebecca Jesseman, a Research and Policy Analyst at Canadian Centre on Substance Abuse, stresses that “continuing care after residential services is part of successful treatment.” These can be community services—whether they are group discussion led by an outpatient service providers or 12-step groups and peer support. Asked about a place like Downtown Eastside, Vancouver, Canada—a notorious open-air drug market, the biggest one in North America—Jesseman admits that aftercare is difficult in those situations but it is possible if the treatment centres are able to prepare their clients before their return and “help them with resiliency skills to protect against contextual factors.”
For Liz, those contextual factors—social and structural characteristics of the environment where she chose to live—trumped her ability to stay clean.
She says, “I certainly wasn’t willing to stop using. No way, I loved it. I just didn’t like what happened when I used.”
For her the wacky 80-grand-a-month program didn’t work and neither did the short-term ones. She says now that it is probably more effective to go longer, “the deeper you’ve gone. To manage 21 days and then to try to manage a life? That would be absolutely a set-up for failure for me.”
The last time she went, she went long-term and she became fully involved in her own recovery. She says she was completely honest with counselors in that she made them aware of her own patterns, things she did to sabotage her sobriety—such as checking out rehab guys that were cute—and that she worked on relapse prevention while inside. She says she needed to change her “entire core belief, what I believed about myself.” It was a slow process but it worked. She laughs, “I didn’t get my apartment until I was four years sober.” She has been sober now for six years.