The Ultimate Guide to Rehab
In addition to these differences, you will find marked differences between treatment centers both in the quality and competency of the staff and the relative comfort of the surroundings. Some treatment centers keep costs down by employing staff who have lower levels of skill than others. Find out if the rehab you’re interested in uses “techs” or fully licensed psychologists to run groups, for example. Techs are generally individuals who have recently gone through treatment themselves and who have no qualifications to run groups other than being alcoholics or addicts in recovery. Often, these individuals are early in recovery (less than five years sober). They run 12-step style meetings, meditations, and other peer-style support groups. Higher quality centers will employ licensed psychotherapists to facilitate group therapy in very small groups, so that all individuals get a true chance to share. This is only one example of the difference between staff members at treatment facilities.
The type of accommodations varies from facility to facility as well. Will you or your loved one stay in a dorm style room with three or more beds in it, or a private room? Will bathrooms be shared? How are rooms cleaned? Do you have any control over whom you room with? The amount of privacy an individual has during treatment can make a big difference to those who need time alone. Others enjoy having company. Some rehabs provide hotel-style rooms or bungalow cabins and others a line of cots. Food may be gourmet or cafeteria style. The setting may be urban or rural, with access to gardens, hiking trails, beaches, forests – or none of the above. Type and quality of living conditions is perhaps not the most important feature of choosing a rehab, but it can be the difference that makes a difference. If you have specific needs, make sure that the facility can meet them.
Rehab vs AA or Other 12-Step Programs
Rehab is great. 12-step programs are great. But they are not the same thing and they are not interchangeable.
Rehab is designed to help addicts detox from the substances they are abusing and give a foundation for recovery in a protected environment. This setting provides a high level of care and most major influences of the “outside” world are kept out of the treatment setting. The safe environment allows the addict to become vulnerable and really focus on the work of overcoming the pain of his/her past. A lot of addicts can’t do that kind of deep work outside the safety of a treatment center. They need more time and space than even intensive outpatient psychotherapy can give. They don’t have the skill to open up and put everything back in place in an hour session so that they can function in the world. Residential treatment provides the opportunity to go into the deepest places of the addict’s emotional and spiritual life with the safety to make changes. It can give a foundation for recovery in the first few months that nothing else can provide.
12-step meetings are a type of self-help or peer support group. The rooms of 12-step programs are full of people who have recovered from addiction and seek to keep themselves sober and help others do the same. In 12-step meetings, an addict will find peers and guides who understand his/her struggle with addiction. They will make themselves available day or night to help when times are rough. They will listen to problems and good sponsors or others will help find solutions. They will help members find a spiritual path and volunteer activities with other addicts that add meaning to the addict’s life. In short, they “get” what you or your loved one is going through. They will not judge, but also won’t put up with a lot of acting out. 12-step programs can provide a lifetime of support.
There need not be an either/or relationship between treatment and 12-step programs.
What are the shortcomings of each activity? Rehab is short term – a few months at most. It is for people in the first hundred or so days of recovery (or for addicts in recovery who have taken pain medication for a medical condition and may need a short stay in a treatment center to prevent a relapse into full-blown addiction). Though it provides tools for living, the main goal of treatment is to provide the skills necessary to live fully and freely outside the facility and to handle the difficulties of life with grace and dignity. Recovery is a life of freedom, not institutionalization! 12-step programs provide outstanding support, but they have a very low recovery rate for those who use them without any other adjunctive therapies – about 8 – 13 percent at one year. Nine out of ten people who use 12-step programs as their only form of treatment will not remain sober for a year. 12-step groups cannot buffer “newcomers” from the challenges of life or the temptations of the world in which the addict lives. They provide relative safety only for the duration of the meeting. Many addicts need more support and a greater variety of therapies than 12-step programs alone can provide.
Outpatient Treatment – Why It Fails to Work
Outpatient treatment programs attempt to provide the therapies of a residential treatment program without the insulation and safety of being secluded in a treatment setting. In an outpatient treatment program, you or the one you love might spend the day engaged in exactly the same type of activities you might in a residential setting: one-on-one psychotherapy, group therapy, 12-step meetings, yoga, mindfulness meditation, etc. But then the individual is sent home, after being vulnerable and open all day, intensely looking at the raw and wounded places in his/her psyche that caused his/her addiction, and is expected to live in the environment in which he or she used drugs without succumbing to ingrained patterns of using again. Does that make any sense at all?
If an individual can get sober without the safety of a residential treatment program, s/he will likely be among the 10 percent or so of people who can find recovery with 12-step meetings alone. These people will find that their lives and the quality of their recovery will improve if they also see a psychotherapist and engage in activities that promote a healthy lifestyle, such as exercise and healthy eating. For all others, residential treatment is optimal.
Outpatient treatment would be appropriate as a stepped-down level of care after residential treatment has been completed. For some, 90 days of inpatient treatment may be enough to give them the tools to live outside the safety of a residential facility, but not enough to return to their homes. A good combination of care for those who have struggled to recover many times and have a history of relapse is residential care followed by outpatient care and residence in a sober living facility. They can then transition out of outpatient services and get a job while continuing to reside in sober living. Only after that will the addict have the skills and experience to transition back home.
The demand of insurance providers that the addict “fail out” of outpatient treatment before being given residential treatment is inhumane and kills people. It is not the level of care most addicts need to recover. Again, the addict who will thrive in outpatient treatment is a member of the 10 percent who will do well with 12-step programs. Most addicts need more care in the initial days of recovery than outpatient treatment provides.
Determining Your Length of Stay
It has already been established that 30 day programs are most often insufficient in duration to help the addict address the underlying causes of his/her addiction and to provide the skills and confidence necessary for the addict to remain clean in his/her community. On average, most people need 90-120 days in treatment to be able to safely step down to a less restrictive level of care. How will you know when you have been in treatment long enough to make a change?
The truth is, you won’t. No matter how comfortable and luxurious the treatment setting, and there are some that are pretty fantastic, few people want to stay in rehab any appreciable length of time. Most addicts want to leave early and many do.
To know when you are ready to leave treatment, you will have to rely on your treatment team; primarily the opinion of your case manager or primary therapist, depending on the facility. They will have a comprehensive and unbiased view of your recovery and will know when you are ready to be discharged.