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Do You Have to Go to Rehab to Get Sober?

Some people require 30 days of expensive inpatient treatment to get sober. Others never step foot in a facility and collect chips like clockwork. So how do you know if you—or your loved one—should seek out a bed?

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They say I have to go to rehab. I say...? Photo via

By Sam Lansky

11/28/11

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I had been to seven rehabs by the time I was 19: a wilderness boot camp in the forests of Utah, a cross-addiction residential program in Kentucky, a psychiatric unit in New Orleans, an inpatient chemical dependency facility in the Sonoran desert, an extended-care halfway-house in Newport Beach, an eating disorder rehab in Arizona, and an intensive outpatient program in Boston. In rehab, I did cognitive behavioral therapy, eye movement desensitization and reprocessing, primal scream therapy, trauma resolution, and group therapy. I attended meetings in six different 12-step programs. I saw psychiatrists, clinical psychologists, psychopharmacologists, social workers, marriage and family health therapists, certified drug and alcohol counselors, and life coaches. I was prescribed selective serotonin reuptake inhibitors, atypical antipsychotics, imidazopyridines, and tricylic antidepressants. I got acupuncture. I finger-painted. I talked about my feelings.

And then I drank again. And again. Step and repeat.

To a civilian, my story probably sounds extreme, but multiple trips to rehab are far from uncommon. In fact, a room full of recovering alcoholics and addicts would greet this tale with a groan of impressed approval. While many most of us encounter more than a few bumps on the road to recovery, more than a few of us enter a vicious, expensive cycle of treatment that's ineffective at best.

“I view rehab as a last-resort measure. It’s important for people to try to get clean and sober on their own, in the context of their lives, before they go into a treatment facility."

Take, for instance, Ramona, an alcoholic from California who’s sober three years and went to treatment at the Caron Foundation after getting a DUI. “I needed rehab," she says. "I had to remove myself from all the triggers and dysfunction in order to focus. There’s no way I would be sober had I not gone.” This is the explanation of many now-sober alcoholics: rehab provided a safe environment in which to do the grueling psychological work required to recover. Still, experts caution, that therapeutic environment is a double-edged sword: once rehab ends, alcoholics return to the real world and all its temptations and stresses—that is, the same factors that caused them to get fucked up in the first place. 

So what is the value of sustained treatment, beyond the initial kick into sobriety that’s provided by inpatient rehab? Jeff Wolfsberg, a drug education specialist who has appeared on The Today Show and The View, says that rehab “serves a great purpose for the current crisis we’re in—prescription drug abuse, for instance. If you were addicted to benzodiazepines, or opiates, or you have a severe addiction to alcohol, you need medical supervision. Although we don’t have a lot of details on Amy Winehouse’s death, it looks like the toxicology report was negative, so she may have died detoxing.” Had she been in rehab, it seems probable, she would have had access to medical assistance she needed to kick her habit safely.

But most addicts don’t sign up for a month at Promises at the first sign of trouble. “I view rehab as a last-resort measure,” says Dr. Paul Hokemeyer, a marriage and family therapist who specializes in addiction psychotherapy and is well known for his appearances on The Dr. Oz Show. “It’s important for people to try to get clean and sober on their own, in the context of their lives, before they go into a treatment facility. For some people, however, AA and therapy isn’t enough to get and keep them clean and sober. They need a safe, contained environment where they can be physically and emotionally stabilized.”

Of course, most addicts put up a great deal of resistance before signing on to take a leave from their lives and hand the power (including, typically, their cell phones) over to a team of strangers out to take away their favorite thing in the world (next to their cell phones). “People are reluctant to make the major commitment of time, money, and disruption to their lives that inpatient—and also, to a degree, outpatient—rehab requires,” says Christopher Murray, a New York-based clinical social worker who specializes in addiction treatment.

While most people are familiar with the notion of the drunk being hauled off to rehab when he can’t put the bottle down, less publicized are those cases when an already sober person decides they to go away. Kacey, a 29-year-old architect with six years of sobriety who lives in North Carolina, spiraled into a deep depression and disordered eating when she was three years sober, and decided to go to treatment for the first time at an eating disorder rehab in Arizona. “I would have started drinking again or I would have killed myself had I not gone, because I was in so much emotional pain,” she explains. “Rehab gave me extra tools by helping me deal with trauma in my past—like childhood abuse that I had never really addressed.” Having a supportive therapeutic community to promote an environment of emotional healing was pivotal for people like Kacey, since the resources she found in 12-step programs weren’t enough to handle the thorny nature of her past. Many alcoholics and addicts have baggage, and those aren’t always things that can be worked through as exhaustively as necessary outside of the context of treatment. An environment that doesn’t disappear once the coffeemaker has been cleaned and the chairs have all been put away— this can be essential to deal with accumulated pain. 

Rehab also buys addicts sober time—or at least enforces an atmosphere where sobriety is mandated—which can sometimes be the most valuable gift for a patient in early recovery. And since many rehabs also recommend the “step-down” model—detox followed by extended care followed by sober living house—graduates are provided with environments where it’s easier to stay sober for longer than just the time they’re in treatment. “We know that it takes people 90 days to learn new behaviors, and step-down programs and sober houses provide the patient with this foundation,” Dr. Hokemeyer says. “Plus, they continue to provide the patient with a social environment that supports their recovery. Addictions thrive in isolation. People heal in relationships with other people who are also healing.”

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