Do You Have to Go to Rehab to Get Sober?

By Sam Lansky 11/28/11

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

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.”

There’s another side benefit to rehab that I learned firsthand: it provides a constant reminder of the gravity of addiction. I know that being there always kept me well aware of the fact that I was damaged enough to need to be in treatment—and that often proved to be the most powerful thing of all. Because, even once I was sober for an extended period of time, that insidious alcoholic voice had a way of returning—lulling me into a place of complacency by whispering that there’s a way to drink safely. When this happens now, I ask myself, “Would a person who is not a real alcoholic have been in seven rehabs?” The answer, I’m fairly confident, is no.

Yet not everyone who has been through treatment thinks that their time was well used. Sara, a student from Oregon who’s been clean for five years, says that not all rehabs are created equal. “Inpatient was necessary,” she says, “I don’t know what my life would look like otherwise. But outpatient was ridiculous—it’s not real. Maybe it helps people who just need a place to ‘be good’ for a while, but it isn’t enough for strong users. If you’ve got a real problem, you have to go away for at least a month, because it’s hard to take it in if you’re still living in the same environment. Outpatient was just something to keep me busy for a few hours.” While I agree with her —in my experience, outpatient was a decent place to check in after I’d already completed a stint in inpatient rehab, but it would have been ineffective as the primary mode of treatment—Abby, a 35 year-old advertising copywriter, credits outpatient with saving her life. “I wasn’t willing to take a leave of absence from work to go away somewhere and I wasn’t willing to go to AA,” she recalls. “I signed up for outpatient, went there every day after work, and slowly acclimated to the idea of AA there. It gave me a version of the program—sort of AA lite—because we had groups where we talked about sobriety, but it was a small, safe environment. I don’t think I’d be sober today had I not gone.”

I’m still not certain, after seven different stints in rehab, and now a few years clean and sober, if rehab was what brought me to a place where I was willing to take responsibility for my behavior. But I certainly don’t think exposure to those facilities hurt. Though I would be wary of crediting any one rehab or type of treatment with finally getting me sober, the cumulative effects of it all left me wiser and more confident in my ability to negotiate a sober lifestyle than I was when I started. The cumulative expense of my tour de rehab of America, however, which would have easily totaled $150,000 before insurance, is perhaps less defensible.

I’m still not certain, after seven different stints in rehab, and now a few years clean and sober, if rehab was what brought me to a place where I was willing to take responsibility for my behavior.

And there’s something to be said for the determination demanded by those recovering from grave addictions without the luxuries of treatment. Talullah, an office administrator who got sober in AA at the age of 18 without going to rehab—and has stayed sober for three years now—says that she didn’t miss out on much by skipping treatment. “I missed out on eating a lot of food at a buffet and getting to go to therapy all the time,” she laughs. “But a lot of people who come out of rehab think that they’ve done the 12 steps already, because you usually do it in rehab with your group. I’ve sponsored a lot of girls who went to rehab—girls who thought they didn’t need to do the work, and then they relapsed. I don’t envy them that. I’m grateful for the experience that I had getting sober in the real world, even if it felt shitty at the time.”

And yet, I can’t help but think that it’s better to over, rather than under, treat those suffering from addiction. “It’s an essentially human characteristic to try and use the least possible resources to resolve a problem,” Murray says. “And we’ve all heard about the man who drank like a fish, woke up one morning at 54, and said, ‘No more.’ But that’s the exception—not the rule. Usually, we try first to go it alone, and that doesn’t tend to work. Time passes, addictions get worse, frayed edges begin to show. Eventually, things get bad enough and we reach a nadir of our despair and just can’t do it anymore—or, most frequently, we hit a crisis moment, it scares the bejesus out of us, and it’s painful enough to get us into action.” This, often, is when we go to rehab—and that’s when real change occurs.

It’s said in 12-step meetings that there’s no wrong way to get sober, just so long as you do—and everyone seems to agree that rehab should be tailored to each patient, rather than made one-size-fits-all. “In the same way that the recovery process is highly individual, the provision of treatment services should be as well,” says Hokemeyer. Whether that means going to rehab seven times or none, this is one instance where it’s not the journey that matters—it’s the destination. 

Sam Lansky is a blogger for Wet Paint and a regular contributor to The Fix who has written about sober coaches and his relationship with his father, among many other topics. Follow him on Twitter at twitter.com/samlansky

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Sam Lansky is the West Coast Editor at TIME. He has written for Rolling Stone, New York Magazine, The Atlantic, Grantland, Cosmopolitan, Esquire, OutBillboard and more. He is also the author of The Gilded Razor. You can find Sam on Linkedin and Twitter.